滕玮利,曹成富,李琪,马玉良,刘健,赵红,卢明瑜,侯昌,王伟民

• 1:北京大学人民医院心血管内科

摘要(Abstract)：

目的评估冠状动脉斑块旋磨术治疗严重钙化病变的临床结果及影响因素。方法连续入选2011年1月至2020年10月于北京大学人民医院因冠状动脉严重钙化病变行斑块旋磨术治疗的280例患者(301处病变),并对患者进行住院期间及出院后随访,分析患者临床基线特征、病变及手术特点、术中并发症以及随访期间主要不良心脑血管事件(MACCE,包括全因死亡、非致死性心肌梗死、靶病变再次血运重建、卒中)发生率及影响因素。结果所有280例患者301处病变中手术即刻成功率97.7%,手术成功病变均置入药物洗脱支架(DES),术中共28处(9.3%)病变发生并发症。术后中位随访26(12,60)个月,Kaplan-Meier曲线估计患者5年累积MACCE发生率为19.6%。Cox回归分析显示慢性肾病(HR3.971,95%CI 1.926～8.187,P<0.001)、左主干病变(HR2.038,95%CI 1.072～3.874,P=0.030)、三支病变(HR2.069,95%CI 1.761～4.588,P=0.003)以及术中发生并发症(HR 5.438,95%CI 2.278～12.982,P<0.001)是发生MACCE的独立预测因素,术中使用血管内超声(IVUS)或光学相干断层成像(OCT)指导(HR 0.236,95%CI 0.088～0.630,P=0.004)是发生MACCE的保护因素。结论冠状动脉斑块旋磨术治疗严重钙化病变手术成功率高,旋磨术联合置入DES可获得较好的远期临床结果。慢性肾病、左主干病变、三支病变以及术中发生并发症是影响患者远期预后的独立危险因素,积极使用IVUS/OCT指导可能改善患者远期预后。

关键词(KeyWords)： 旋磨术;冠心病;钙化病变;影响因素

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 滕玮利,曹成富,李琪,马玉良,刘健,赵红,卢明瑜,侯昌,王伟民

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