紫杉醇药物涂层球囊治疗老年冠心病患者原发病变的疗效和安全性

摘要

目的 研究紫杉醇药物涂层球囊(DCB)治疗≥65岁老年人原发冠脉病变的安全性和有效性.方法 对北京医院心导管室158例接受DCB治疗原发病变的连续病例进行回顾性分析,其中63例≥65岁,95例＜65岁,对其临床特点和冠脉造影结果进行比较.结果 老年组高血压(65.1％和56.8％)、房颤(7.9％和2.1％)、经皮冠状动脉介入术(PCI)史(44.4％和23.2％,P＜0.01)和非ST段抬高心肌梗死(NSTEMI)(14.3％和4.2％,P＜0.05)患者较多,非老年组男性比例(71.6％和50.8％,P＜0.05)、吸烟者(52.3％和30.2％,P＜0.01)较多.老年组病变复杂,钙化病变比例明显增加(36.8％和14.0％,P＜0.01),但操作成功率高于非老年组.两组DCB术后即刻最小管腔直径(MLD)均显著增加.非老年组1例在术后第四天因靶病变急性血栓形成行紧急血运重建(TLR),老年组住院期间无主要不良心血管事件(MACE)发生.21例患者在平均9个月后进行冠脉造影随访,定量冠脉血管造影分析(QCA)结果显示MLD略有增加(2.00±0.67) mm和(1.91±0.47)mm,(P＞0.05),晚期管腔丢失(LLL)为(-0.09±0.50)mm,但差异无统计意义.在平均9个月的临床随访中,老年组和非老年组MACE发生率分别为1.6％和1.1％,TLR分别为0.0％和1.1％(均P＞0.05).两组均无死亡发生.结论 与非老年冠心病患者相比,DCB治疗老年冠心病患者的冠脉原发病变,同样具有良好的疗效和安全性.%Objective To evaluate the efficacy and safety of Paclitaxel drug coated balloon (DCB) (SeQuent Please) in an elderly patients with de novo coronary disease.Methods We performed a retrospective study of 158 consecutive patients (63 patients aged ≥65 yrs and 95 patients aged ＜65 yrs) received DCB therapy in Cath Lab of Beijing Hospital.Clinical characteristic was recorded and coronary angiography was analyzed with quantitative coronary angiography (QCA) software.Results In elderly group,more patients have hypertension (65.1％ vs.56.8％),atrial fibrillation (7.9％ vs.2.1％),previous percutaneous coronary intervention (PCI) history (44.4％ vs.23.2％,P＜0.01) and non ST-elevated myocardial infarction (NSTEMI) (14.3％ vs.4.2％,P ＜0.05).In non-elderly group,more patients were male (71.6％ vs.50.8％,P＜0.05) and current smoker (52.3％ vs.30.2％,P＜ 0.01).Old patients had more complicated lesions,especially calcified lesions (36.8％ vs.14.0％,P＜0.01).Despite of that,our study showed a higher success rate of PCI in elderly group.Both groups of patients showed significant acute gain in minimal lumen diameter (MLD) after DCB released.At 4 days post-operation,there was one case that underwent acute myocardial infarction requiring emergent target lesion revascularization (TLR) in non-elderly group.No major adverse cardiac event (MACE) was observed in the elderly group during hospitalization.Twenty-one patients underwent coronary angiographic followed up at average 9 months post PCI.The QCA analysis showed that MLD of lesions treated with DCB had mildly increased [(2.00±0.67) mm vs.(1.91 ± 0.47) mm,P＞0.05],the late lumen loss (LLL) was (-0.09±0.50) mm.At 9 months follow-up,the MACE rate in the elderly group was 1.6％ and 1.1％ in non-elderly group,with TLR rates at 0.0％ and 1.1％ respectively (both P＞0.05).No death was observed in either group.Conclusions The efficacy and safety of DCB on the elderly patients with de novo lesions is as good as non-elderly patients despite more complex anatomy and comorbidities.