Clinical Value Of Intravascular Ultrasound-guided Drug-coated Balloon Therapy For Coronary Artery Lesions In Situ

Background:Acute coronary syndromes(ACS)include acute ST-segment elevation myocardial infarction(STEMI),acute non-ST-segment elevation myocardial infarction(NSTEMI)and unstable angina(UA).Current treatment modalities include pharmacological therapy and hemodynamic reconstruc-tion therapy,of which drug-coated balloon(DCB)and drug-eluting stent(DES)are two types of hemodynamic reconstruction therapy.Although drug-eluting stents can inhibit intimal hyperplasia and further reduce the incidence of in-stent restenosis ISR,metal carriers are still left in the coronary arteries,and the problem of in-stent restenosis has not been completely solved.Drug-coated balloons are a new tool for treating patients with coronary artery disease.the main feature of this technique is the rapid and homogeneous transfer of antiproliferative drugs(paclitaxel)into the vessel wall during balloon expansion,which inhibits intimal hyperplasia and does not leave foreign bodies after vasodilation.the safety and efficacy of DCB in in-stent restenosis(ISR)and small vessels have been well demonstrated,and DCB is currently used in bifurcation lesions The use of DCB in bifurcation lesions,large vessels,and patients with high bleeding risk has received increasing evidence-based medical support,and its use in coronary artery in situ vascular lesions will tend to increase.Currently,IVUS and coronary angiography are the two most commonly used modalities to guide drug-coated balloon placement.Among them,a number of studies have shown the advantage of IVUS over coronary angiography in guiding DES.IVUS can penetrate the tissue,reflecting the vascular structure and obtaining images of the vessel and its surrounding tissue.In ill-defined lesions,ultrasound allows quantification of the lesion,especially in left main coronary artery disease.residual plaque burden obtained by IVUS is the most useful predictor of clinical outcome.And IVUS-guided DCB treatment can reduce major adverse cardiovascular events(MACE)compared to angiography-guided DCB treatment.The main objective of this study was to investigate whether IVUS is safer and more effective thancoronary angiography for the application of DCB to treat patients with coronary artery lesions in situ.Purpose:To observe the clinical value of intravascular ultrasound(IVUS)guided drug-coated balloon(DCB)for the treatment of coronary artery lesions in situ,whether the application of IVUS can reduce the occurrence of adverse cardiovascular events in patients,to observe whether intraoperative complications in patients will be reduced after treatment,and to explore the independent risk factors affecting MACE events.Method:Two hundred and seventy patients with acute coronary syndromes who were hospitalized in the Department of Cardiology of Qingdao Municipal Hospital from July 2019 to July 2021,who underwent DCB guided by IVUS or coronary angiography(CAG)and whose imaging showed in situ lesions,were divided into a coronary angiography group(n=170)and an intravascular ultrasound group(n=100),and the two groups were counted for coronary stenosis,plaque loading,intraoperative complications,and major adverse cardiovascular events(MACE)occurring within 1 year after discharge from the hospital.In addition,general clinical data were collected from both groups at admission: sex,age,history of smoking,history of hypertension,history of diabetes mellitus,previous cardiovascular events(history of myocardial infarction,angina,coronary revascularization,atherosclerotic stroke,etc.),family history of heart disease,blood glucose,blood creatinine,apolipoprotein A1,HDL cholesterol,BNP,left ventricular ejection fraction,and whether there was segmental heart disease.The study was conducted to determine whether there were any segmental ventricular wall motion abnormalities.Results:1.There was no statistically significant difference between the IVUS group and the coronary angiography group in terms of age,gender,history of hypertension,history of diabetes mellitus,history of coronary artery disease,history of smoking,family history,blood glucose,blood creatinine,apolipoprotein A1,HDL cholesterol,BNP,left ventricular ejection fraction,and presence of segmental ventricular wall motion abnormalities,P>0.05.2.Analysis of surgical data and intraoperative complications of acute coronary syndrome patients in the IVUS group and coronary angiography group.There was no statistically significant difference in the degree of stenosis betweenacute coronary syndrome patients in the IVUS group and the coronary angiography group(90.57±8.15% vs 88.67±7.93 %,P=0.161).The plaque load in the coronary convict vessels was higher in men than in women(80.66±9.64% vs.74.00±11.48%,p=0.049),and the comparative analysis of intraoperative complications in the IVUS group and the coronary angiography group were not statistically significant(p>0.05).3.The mean age of the MACE group was older than that of the non-MACE group(70.93±11.59 vs.64.77±11.98,p=0.012),the degree of stenosis of the offender vessels was more severe in the MACE group than in the non-MACE group(94.21±5.84% vs.89.02±9.07%,p=0.016),and the plaque load was greater in the MACE group than in the non-MACE group(90.75±11.06% vs77.77±9.86%,P=0.016).segmental ventricular wall motion abnormalities were more prevalent in the MACE group than in the non-MACE group(72.2%vs 37.6%,P=0.006),and gender,HDL cholesterol,apolipoprotein A1,BNP,left ventricular ejection fraction,glucose,blood creatinine values and Age(OR=1.052,95% CI: 1.011-1.094,P=0.011),plaque load(OR=1.173,95% CI: 1.026-1.341,P=0.020),and degree of coronary stenosis(OR=1.099,95% CI: 1.016-1.189)were not significantly different from those in the non-MACE group.1.016 to 1.189,P=0.018)and segmental ventricular wall motion abnormalities(OR=4.312,95% CI: 1.433 to 12,978,P=0.009)were independent risk factors for the occurrence of MACE events with DCB treatment.4.The incidence of MACE events at 1 year was statistically lower in the IVUS group of acute coronary syndrome patients compared with the coronary angiography group(12.0% vs.5.0%,P=0.036).There was no significant difference between the IVUS group and the coronary angiography group in terms of recurrent acute coronary syndrome syndrome(3.0% vs.5.9%,P=0.285),stroke(0% vs.1.8%,P=0.298),and acute heart failure(1% vs.3.5%,P=0.265).There was one cardiac death in both groups,but it was not statistically significant.Conclusion:In summary,age,plaque load,degree of coronary stenosis,and segmental ventricular motion abnormalities are risk factors affecting the occurrence of major adverse cardiovascular events with drug-coated balloon therapy.Compared with coronary angiography,intravascular ultrasound can better guide drug-coated balloon therapy for coronary in situ vascular lesions,reduce the occurrence of major adverse cardiovascular events,and improve the prognosis of patients.