| BACKGROUND AND AIMS:Coronary atherosclerotic heart disease(CHD)is currently one of the leading causes of death for urban and rural residents in China,and the mortality of CHD is increasing steadily,especially in patients who suffer from acute coronary syndrome(ACS).ACS includes unstable angina(UA),non-ST segment elevation myocardial infarction(NSTEMI)and ST segment elevation myocardial infarction(STEMI).According to the "ANNUL REPORT ON CARDIOVASCULAR HEALTH AND DISEASES IN CHINA 2019",mortality caused by acute myocardial infarction(AMI)displayed an increasing trend from 2002 to 2017 in China.Meanwhile,the mortality of these patients had showed an ascending trend with aging.Nowadays,percutaneous coronary intervention(PCI),which can effectively reduce the mortality of patients with ACS,had gradually become the mainstay of treatment for ACS.Comparing with plain old balloon angioplasty(POBA)and bare mental stents(BMS),although the new-generation drug eluting stent(DES)is still the main devices in PCI,DES didn’t lower the mortality in patients with ACS.Moreover,the worries of in-stent restenosis had raised the misgivings of cardiologist.Therefore,the strategy of "Leaving nothing behind" is enjoying more and more acceptance for treatment in CHD.Drug-coated balloon(DCB),leaving no polymer matrix and metal stents in coronary artery,is a new intervention devices.Most of the studies showed DCB was not inferior to DES in in-stent restenosis and de novo small coronary artery diseases.However,the safety and efficacy of DCB in ACS remains to be further studies.Therefore,we designed this retrospective study to compare the short-term safety and efficacy of DCB and DES in patients with ACS.METHODS:A total of 110 patients who undergone emergency coronary angioplasty and were diagnosed with ACS were included retrospectively in Zhujiang Hospital of Southern Medical University,Foshan Sanshui District People’s Hospital,and Panyu Branch of the Second Affiliated Hospital of Guangzhou Medical University from January 2017 to May 2020.The patients were divided into DCB group(n=40)and DES group(n=70)according to treatment devices.The clinical baseline between the 2 groups were collected from electronic medical record.The Characteristics of lesions,medications in operation,operative procedures and surgical complications were collected from electronic medical record and coronary angiogram.The primary end point was late lumen loss(LLL)in follow-up.The secondary end points include major cardiovascular adverse events(MACE),target vessel thrombosis and major bleedings.Data processing and statistical analysis were performed using the SPSS statistics version 22.0.RESULTS:There were 36(90%)men in DCB group and 57(81.4%)men in DES group.The baseline characteristics of hypertension,diabetes mellitus,hypercholesterolemia,smoking,previous PCI,previous AMI did not significantly differ between the 2 groups(p>0.05).There was no significantly differ in median follow-up time between the 2 groups[DCB vs DES,7.82 months(interquartile range:6.08 to 11.80)vs 10.73 months(interquartile range:7.01 to 12.2)].The LLL at the follow-up was 0.11mm(interquartile range:-0.11 to 0.36)in the DCB group,whereas in the DES group it was 0.06mm(interquartile range:0.01 to 0.16)(p=0.51).During the follow up,there were 3(7.5%)cases of TLR,2(5.0%)cases of target lesion related myocardial infarction,0(0.0%)cases of cardiac death,3(7.5%)cases of MACE,1(2.5%)cases of target vessel thrombosis,0(0.0%)cases of major bleedings in DCB group.In DES group,there were 4(5.7%)cases of TLR,1(5.0%)cases of target lesion related myocardial infarction,0(0.0%)cases of cardiac death,4(5.7%)cases of MACE,2(2.9%)cases of target vessel thrombosis,0(0.0%)cases of major bleedings.Our results showed no differences in MACE(DCB vs DES,7.5%vs 5.7%,p=0.703),target vessel thrombosis(DCB vs DES,2.5%vs 2.9%,p=1)and major bleedings.CONCLUSION:DCB-only strategy can be used as a safe treatmentin ACS.However,we need further selection before making this decision. |
PDF Full Text Request