论文部分内容阅读
目的:评价直接旋磨处理冠状动脉钙化病变的效果。方法:回顾性分析2010-04至2014-09我院行冠状动脉旋磨治疗的冠心病患者137例,其缺血相关病变均为钙化病变。根据旋磨前是否进行球囊扩张,分为直接旋磨组81例和预扩旋磨组56例。比较两组术中操作特征,术中即刻并发症,及患者院内和术后1年累积主要不良心脑血管事件(MACCE)发生率。结果:与预扩旋磨组比,直接旋磨组支架前使用球囊数量低(P=0.000)、最大后扩压力高(P=0.004)。直接旋磨组术中并发症显著低于预扩旋磨组(14.8%vs 32.1%,P=0.016);且术后即刻管腔获得率显著高于预扩旋磨组[(128.52±75.77)%vs(77.12±27.01)%,P=0.004]。与预扩旋磨组相比,直接旋磨组有较低的1年MACCE事件发生率(7.3%vs 23.6%,P=0.006)。Cox回归分析:冠状动脉旋磨处理钙化病变1年MACCE事件的主要相关因素为旋磨前球囊扩张[风险比(HR)=8.166,95%可信区间(CI):1.872~35.614,P=0.005]、左主干病变(HR=13.649,95%CI:2.983~62.440,P=0.001)、术后最小管腔面积(HR=0.583,95%CI:0.378~0.879,P=0.010)、后扩(HR=0.066,95%CI:0.013~0.332,P=0.001)、射血分数大于40%(HR=0.019,95%CI:0.002~0.158,P=0.000)。结论:直接旋磨有较低的1年MACCE事件发生率。这一获益可能与直接旋磨可以进行有效球囊扩张、减少术中并发症、并获得足够的管腔面积有关。
Objective: To evaluate the effect of direct rotational atherectomy on coronary artery calcification. Methods: A retrospective analysis of 137 patients with coronary heart disease treated by rotational atherectomy in our hospital from 2010-04 to 2014-09 was performed. The ischemic-related lesions were calcified. According to whether the rotation before the balloon dilatation, divided into direct rotation group of 81 cases and pre-expansion group of 56 cases of rotation grinding. The intraoperative operative characteristics, immediate intraoperative complications, and the incidence of major adverse cardiac and cardiovascular events (MACCE) in the hospital and postoperative one year were compared between the two groups. Results: Compared with the pre-rotation rotation group, the number of balloons used before the direct rotation group was lower (P = 0.000) and the maximum posterior pressure was higher (P = 0.004). The complications of direct rotation group were significantly lower than those of pre-expansion rotation group (14.8% vs 32.1%, P = 0.016). The immediate lumen acquisition rate was significantly higher than that of pre-augmentation group [(128.52 ± 75.77) % vs (77.12 ± 27.01)%, P = 0.004]. In the direct rotational atherectomy group, there was a lower 1-year incidence of MACCE events (7.3% vs 23.6%, P = 0.006) compared to the pre-augmentation group. Cox regression analysis: Coronary rotational atherectomy One of the major MACCE events associated with calcification was balloon dilatation prior to spin-milling (hazard ratio (HR) = 8.166, 95% confidence interval (CI): 1.872 to 35.614, P = (P <0.001). The number of left main trunk lesions (HR = 13.649,95% CI: 2.983 ~ 62.440, P = 0.001) and postoperative minimal lumen area (HR = 0.583, 95% CI: 0.378-0.879, P = 0.010) (HR = 0.066, 95% CI: 0.013-0.332, P = 0.001). The ejection fraction was more than 40% (HR = 0.019, 95% CI: 0.002-0.158, P = 0.000). Conclusions: Direct spin-on has a lower incidence of MACCE events at 1 year. This benefit may be related to direct rotational atherectomy for effective balloon dilation, reduced intraoperative complications, and adequate lumen area.