2025 年第 9 期 第 20 卷

药物涂层球囊导管治疗冠状动脉原位小血管病变晚期管腔丢失对心血管不良事件的影响

Effect of drug-coated balloon catheter on late lumen loss in patients with de novo coronary small vessel disease on adverse cardiovascular events

作者：史云聪1赵腾啸1林立1唐熠达2王贵松2傅国胜3王乐丰4陈良龙5刘喜6刘斌7 陈晖8刘刚9唐强10曾勇1

英文作者：Shi Yuncong1 Zhao Tengxiao1 Lin Li1 Tang Yida2 Wang Guisong2 Fu Guosheng3 Wang Lefeng4 Chen Lianglong5 Liu Xi6 Liu Bin7 Chen Hui8 Liu Gang9 Tang Qiang10 Zeng Yong1

单位：1首都医科大学附属北京安贞医院冠心病三科，北京100029；2北京大学第三医院心内科，北京100191；3浙江大学医学院附属邵逸夫医院心内科，杭州310009；4首都医科大学附属北京朝阳医院心内科，北京100020；5福建医科大学附属协和医院心内科，福州350001；6内蒙古自治区人民医院心内科，呼和浩特750306；7吉林大学第二医院心内科，长春130041；8首都医科大学附属北京友谊医院心内科，北京100050；9河北医科大学第一医院心内科，石家庄050051；10北京大学首钢医院心内科，北京100144

英文单位：1Third Department of Coronary Heart Disease Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Cardiology Peking University Third Hospital Beijing 100191 China; 3Department of Cardiology Sir Run Run Shaw Hospital Zhejiang University School of Medicine Hangzhou 310009 China; 4Department of Cardiology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China; 5Department of Cardiology Fujian Medical University Union Hospital Fuzhou 350001 China; 6Department of Cardiology Inner Mongolia People′s Hospital Hohhot 750306 China; 7Department of Cardiology The Second Hospital of Jilin University Changchun 130041 China; 8Department of Cardiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 9Department of Cardiology The First Hospital of Hebei Medical University Shijiazhuang 050051 China; 10Department of Cardiology Peking University Shougang Hospital Beijing 100144 China

关键词：药物涂层球囊；晚期管腔丢失；心血管不良事件；小血管病变

英文关键词：Drug-coatedballoon;Latelumenloss;Adversecardiovascularevents;Smallvesseldisease

• 摘要：

• 目的 探究药物涂层球囊导管治疗冠状动脉原位小血管病变晚期管腔丢失对心血管不良事件的影响。方法 选取2021年3—6月在全国14家医院收治的256例因冠状动脉原位小血管病变行经皮冠状动脉介入术的患者（术后组），收集患者的基本资料、住院相关检查和手术信息，并于术后9个月时进行造影随访，记录病变节段内晚期管腔丢失、靶病变再狭窄率等情况。共194例完成随访至术后1年（随访组），观察受试者相关的心血管临床复合终点（POCE）和器械导向的复合终点（DOCE）。结果 研究对象年龄（63±9）岁，术前最小管腔直径（0.62±0.25）mm，术前狭窄程度（70±11）%，术前参考血管直径（2.1±0.3）mm，术前病变长度（11±5）mm，术前心肌梗死溶栓试验血流分级3级247例（96.5%）。术后组和随访组节段内最小管腔直径、节段内残余狭窄程度、球囊扩张段最小管腔直径、球囊扩张段残余狭窄程度比较，差异均有统计学意义（均P＜0.001）。多因素Cox回归分析结果显示，术后随访1年，在校正相关危险因素（性别、年龄、收缩压、舒张压、心率、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、血肌酐）后，节段内晚期管腔丢失为POCE和DOCE的独立危险因素（均P<0.001）。结论 药物涂层球囊导管治疗冠状动脉原位小血管病变晚期管腔丢失增加可能是心血管不良事件的独立危险因素。

• Objective To investigate the effect of drug-coated balloon catheter on late lumen loss and adverse cardiovascular events in patients with de novo coronary small vessel disease. Methods A total of 256 patients with de novo small vessel coronary artery disease who underwent percutaneous coronary intervention in 14 hospitals in China from March to June 2021 were selected as the postoperative group. The basic data, hospitalization related examination and operation information of the patients were collected, and the follow-up angiography was performed at 9 months after operation to record the late lumen loss in the affected segment and the rate of target lesion restenosis. A total of 194 patients were followed up for 1 year (follow-up group). The patient-related cardiovascular clinical composite endpoint (POCE) and device oriented composite endpoint (DOCE) were observed. Results The mean age of the study subjects was (63±9)years, the preoperative minimum lumen diameter was (0.62±0.25)mm, the preoperative stenosis degree was (70±11)%, the preoperative reference vessel diameter was (2.1±0.3)mm, the preoperative lesion length was (11±5)mm, and 247 cases (96.5%) were thrombolysis in myocardial infarction trial flow grade Ⅲ. There were significant differences in the minimum lumen diameter in the segment, the degree of residual stenosis in the segment, the minimum lumen diameter in the balloon dilatation segment, and the degree of residual stenosis in the balloon dilatation segment between the postoperative group and the follow-up group (all P＜0.001). Multivariate Cox regression analysis showed that late segmental lumen loss was an independent risk factor for POCE and DOCE after adjusting for related risk factors (gender, age, systolic blood pressure, diastolic blood pressure, heart rate, low-density lipoprotein cholesterol, total cholesterol, triglyceride, and serum creatinine) at 1 year follow-up (both P<0.001). Conclusion Increased late lumen loss after drug-coated balloon catheter treatment of de novo coronary small vessel disease may be an independent risk factor for adverse cardiovascular events.