Analysis Of Risk Factors Associated With Restenosis Of Target Lesions After Drug Coated Balloon Angioplasty For De Novo Coronary Disease

BackgroudCoronary heart disease(CHD)is a heart disease caused by myocardial ischemia and necrosis due to stenosis or occlusion caused by atherosclerosis or spasm of the coronary arteries,which is a common disease endangering the life and health of urban and rural residents in China.The treatment of CHD includes conservative medical treatment,coronary artery bypass graft(CABG)and percutaneous coronary intervention(PCI).Due to the large surgical trauma and slow recovery,PCI has become the main method to treat CHD patients.Restenosis at the target lesion after PCI is one of the main reasons affecting the prognosis of patients.Although the incidence of restenosis has been significantly reduced with the use of drug-eluting stents(DES),it is still 10%.A lot of studies have confirmed that there are many factors affecting restenosis after PCI,such as:diabetes,hyperlipidemia,type of stent or balloon,and type of lesion.Drug-coated balloon(DCB)is a new method of coronary intervention after DES.It rapidly releases the anti-proliferative drugs evenly applied on the balloon surface to the target lesion vessel wall,so as to achieve the purpose of anti-intimal hyperplasia.DCB has shown good efficacy and safety in the treatment of in-stent restenosis(ISR),and also reflects certain advantages in the treatment of in de novo lesions including small vessel lesions and bifurcation lesions.However,there are few studies on the risk factors associated with restenosis of target lesions after drug-eluting balloon angioplasty in de novo coronary artery lesions at home and abroad.ObjectiveTo investigate the risk factors associated with target lesion restenosis after drug coated balloon angioplasty in de novo coronary artery disease.MethodsA total of 134 patients with coronary heart disease who underwent successfully DCB angioplasty for in de novo coronary artery disease and underwent coronary angiography(CAG)from January 2016 to January 2019 in the First Affiliated Hospital of Zhengzhou University were enrolled.According to the results of reexamination of angiography,the patients were divided into the restenosis group and the non-restenosis group.Among them,there were 24 patients in the restenosis group,with an average age of 60.3±11.2 years.There were 110 patients in the non-restenosis group,with an average age of 59.0±10.9 years.A total of 156 vessels in the two groups underwent successfully DCB angioplasty,of which 29 had target vessel restenosis and 127 had no restenosis.Univariate analysis was performed withχ 2-test or t-test to compare the clinical data(age,gender,smoking history,hypertension history,diabetes history,etc.)and target lesion characteristics(target vessel diameter,target lesion location,target lesion length,type of pre-dilatation balloon,etc.)between the two groups.Multivariate logistic regression analysis was used to analyze the factors associated with restenosis.Results1.In the clinical data of patients,the hypertension(66.7%vs 43.6%,P=0.041),diabetes(58.3%vs 33.6%,P=0.024)and smoking history(62.5%vs 38.2%,P=0.029)of patients in the restenosis group were higher than those in the group without restenosis,and the difference was statistically significant;2.In the characteristics of target lesions,compared with the group without restenosis,the length of target lesions in the restenosis group was significantly longer(18.9±5.3mm vs 16.8±4.2mm,P=0.021),and the proportion of cutting balloon/spinous process balloon predilatation was lower(48.3%vs 76.4%,P=0.002),and the difference was statistically significant.3.The results of multivariate logistic regression analysis showed that diabetes(OR=3.002,95%CI:1.164～7.744)and smoking(OR=2.682,95%CI:1.038～6.949)were independent risk factors for restenosis in patients(P<0.05);target lesion length(OR=1.113,95%CI:1.012～1.225)was an independent risk factor for restenosis in target lesions,and cutting balloon/spinous process balloon predilatation(OR=0.284,95%CI:0.121～0.666)was a protective factor(P<0.05).ConclusionDiabetes mellitus,smoking and target lesion length were independent risk factors for target lesion restenosis after DCB angioplasty in de novo coronary lesions,and cutting balloon/spinous process balloon predilatation was a protective factor.