补救性旋磨技术在冠状动脉钙化病变中的应用分析Safety and efficacy of rescue coronary rotational atherectomy for treating calcified lesions
张慧平,赵迎,郑耐心,唐国栋,艾虎,李辉,杨国建,夏博,孙福成
摘要(Abstract):
目的分析补救性旋磨在冠状动脉钙化病变治疗中的安全性和有效性。方法回顾2012年1月至2017年12月连续在北京医院接受冠状动脉内旋磨治疗的123例冠心病患者,分为主动性旋磨组(96例)和补救性旋磨组(27例),比较两组旋磨治疗的特征、围术期并发症和1年心血管事件,包括因心绞痛、心肌梗死、心力衰竭而再次住院或行再次血运重建以及心血管死亡。结果主动性旋磨组最大预扩张压力显著低于补救性旋磨组[12.0(10.0,16.0)atm比16.0(12.0,18.0)atm,P=0.002,1 atm=101.325 k Pa];两组其他旋磨治疗的特征比较,差异均无统计学意义(均P>0.05)。主动性旋磨组共有17例(17.7%)发生旋磨围术期并发症,补救性旋磨组为6例(22.2%),差异无统计学意义(P=0.595),并发症大多轻微。主动性旋磨组和补救性旋磨组患者即刻手术成功率均较高(99.0%比96.3%,P=0.916),1年心血管事件发生率(12.7%比18.8%,P=0.512)相当。两组患者均未发生1年心血管死亡。多因素分析显示,旋磨围术期并发症对旋磨患者1年心血管事件的比值比(OR)为6.650(95%CI 1.506~29.370,P=0.012)。结论补救性旋磨治疗不显著增加旋磨围术期并发症的发生率,即刻手术成功率高,发生旋磨围术期并发症是旋磨患者1年心血管事件的独立危险因素。
关键词(KeyWords): 冠心病;经皮冠状动脉介入治疗;斑块旋磨术;主动性;补救性
基金项目(Foundation):
作者(Author): 张慧平,赵迎,郑耐心,唐国栋,艾虎,李辉,杨国建,夏博,孙福成
参考文献(References):
- [1]Warth DC,Leon MB,O'Neill W,et al.Rotational atherectomy multicenter registry:acute results,complications and 6-month angiographic follow-up in 709 patients.J Am Coll Cardiol,1994,24(3):641-648.
- [2]罗建方,董豪坚,李光,等.冠状动脉斑块旋磨术并发症分析.中华心血管病杂志,2013,41(6):470-473.
- [3]温尚煜,尚瑞平,于宏颖,等.冠状动脉内旋磨术并发症分析、预防及处理技巧.中国介入心脏病学杂志,2017,25(12):677-681.
- [4]Tomey MI,Kini AS,Sharma SK.Current status of rotational atherectomy.JACC Cardiovasc Interv,2014,7(4):345-353.
- [5]方唯一,施鸿毓.磨不磨?——钙化病变的影像学评估.中国介入心脏病学杂志,2015,23(10):595-597.
- [6]葛均波,王伟民,霍勇.冠状动脉内旋磨术中国专家共识.中国介入心脏病学杂志,2017,25(2):61-66.
- [7]Kawamoto H,Latib A,Ruparelia N,et al.Planned versus provisional rotational atherectomy for severe calcified coronary lesions:Insights From the ROTATE multi-center registry.Catheter Cardiovasc Interv,2016,88(6):881-889.
- [8]Ma YC,Zuo L,Chen JH,et al.Modifi ed glomerular fi ltration rate estimating equation for Chinese patients with chronic kidney disease.J Am Soc Nephrol,2006,17(10):2937-2944.
- [9]Ryan TJ,Faxon DP,Gunnar RM,et al.Guidelines for percutaneous transluminal coronary angioplasty.A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures(Subcommittee on Percutaneous Transluminal Coronary Angioplasty).Circulation,1988,78(2):486-502.
- [10]Aldrich RF,Brensike JF,Battaglini JW,et al.Coronary calcif ications in the detection of coronary artery disease and comparison with electrocardiographic exercise testing.Results from the National Heart,Lung,and Blood Institute's type II coronary intervention study.Circulation,1979,59(6):1113-1124.
- [11]Barbato E,CarriéD,Dardas P,et al.European expert consensus on rotational atherectomy.Euro Intervention,2015,11(1):30-36.
- [12]Dorros G,Cowley MJ,Simpson J,et al.Percutaneous transluminal coronary angioplasty:report of complications from the National Heart,Lung,and Blood Institute PTCA Registry.Circulation,1983,67(4):723-730.
- [13]Tsubokawa A,Ueda K,Sakamoto H,et al.Acute and long-term outcomes of rotational atherectomy in small(<3.0 mm)coronary arteries.J Interv Cardiol,2003,16(4):315-322.
- [14]中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016).中华心血管病杂志,2016,44(5):382-400.
- [15]孙勇,蒋峻,朱国忠,等.血管内超声指导下冠状动脉严重钙化病变旋磨治疗的有效性.中华心血管病杂志,2014,42(7):545-550.
- [16]孙婷,白静,王禹,等.直接旋磨和球囊预扩旋磨治疗冠状动脉钙化病变的对比研究.中国循环杂志,2016,31(4):327-331.
- [17]李琪,刘健,卢明瑜,等.斑块旋磨术联合药物洗脱支架置入术治疗冠状动脉弥漫性严重钙化病变的近期效果分析.中国介入心脏病学杂志,2016,24(12):667-671.
- [18]赵兵兵,李滔,田刚,等.冠状动脉旋磨术联合药物洗脱支架置入术治疗冠状动脉严重钙化病变的临床研究.中国介入心脏病学杂志,2017,25(3):158-162.
- [19]Arora S,Panaich SS,Patel N,et al.Coronary atherectomy in the United States(f rom a nationwide inpatient sample).Am J Cardiol,2016,117(4):555-562.