2026 年第 6 期 第 21 卷

真实世界中冠心病患者不同血运重建策略的疗效与安全性比较

Comparison of efficacy and safety of different revascularization strategies in patients with coronary atherosclerotic heart disease in the real world

作者：龚强许巧玲韩亚珠

英文作者：Gong Qiang Xu Qiaoling Han Yazhu

单位：河北省保定市第一中心医院心内科，保定071000

英文单位：Department of Cardiology Baoding No.1 Central Hospital Hebei Province Baoding 071000 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；经皮冠状动脉腔内成形术；药物洗脱支架；药物涂层球囊；主要不良心血管事件；出血风险

英文关键词：Coronaryatheroscleroticheartdisease;Percutaneoustransluminalcoronaryangioplasty;Drug-elutingstent;Drug-coatedballoon;Majoradversecardiovascularevents;Bleedingrisk

• 摘要：

• 目的 比较真实世界中冠心病（冠状动脉粥样硬化性心脏病）患者分别接受单纯经皮冠状动脉腔内成形术（PTCA）、药物洗脱支架（DES）或药物涂层球囊（DCB）治疗后的疗效与安全性差异。方法 采用回顾性队列研究设计，纳入2022年1月至2024年10月于河北省保定市第一中心医院行介入治疗的冠心病患者，根据手术方式分为PTCA组、DES组与DCB组。采用倾向评分匹配按1∶1∶1比例均衡组间基线资料，最终各组纳入70例患者。主要疗效终点为术后1年内主要不良心血管事件（MACE，包括心源性死亡、非致死性心肌梗死及缺血驱动的靶病变血运重建），安全性终点包括出血学术研究会2～5型出血与支架内血栓。结果 3组手术成功率均较高［PTCA组92.9%（65/70）比DES组97.1%（68/70）比DCB组98.6%（69/70），P=0.185］。随访期间，PTCA组、DES组、DCB组3组间MACE发生率差异无统计学意义［20.0%（14/70）比17.1%（12/70）比8.6%（6/70）］（P=0.147）。在安全性方面，PTCA组的出血事件发生率较低［10.0%（7/70）］，且无支架内血栓发生。多因素Cox回归分析显示，年龄（每增加1岁）、糖尿病、急性冠状动脉综合征、病变分型（B2/C型）以及靶病变血管为左前降支均为MACE发生的风险因素（均P<0.05）。结论 在真实世界临床实践中，经倾向评分匹配的冠心病队列，单纯PTCA作为“介入无植入”理念的代表，在特定病变中展现出良好的应用价值，其手术成功率与DES、DCB相当，且具有较低的出血风险和零支架内血栓发生的安全性优势。临床应根据病变特点与患者个体情况合理选择血运重建策略，PTCA仍是特定人群的重要治疗选择。

• Objective To compare the efficacy and safety of percutaneous transluminal coronary angioplasty (PTCA) alone, drug-eluting stents (DES) and drug-coated balloons (DCB) in patients with coronary atherosclerotic heart disease in the real world. Methods A retrospective cohort study was conducted. Patients with coronary heart disease who underwent interventional therapy in Baoding No.1 Central Hospital, Hebei Province from January 2022 to October 2024 were enrolled and divided into PTCA group, DES group and DCB group according to surgical methods. Propensity score matching was used to balance baseline data among groups at a ratio of 1∶1∶1, and finally 70 patients were included in each group. The primary efficacy endpoint was major adverse cardiovascular events (MACE, including cardiac death, non-fatal myocardial infarction and ischemia-driven target lesion revascularization) within 1 year after operation. Safety endpoints included bleeding academic research consortium type 2-5 bleeding and in-stent thrombosis. Results The surgical success rates were high in all three groups ［92.9%(65/70) in PTCA group vs 97.1%(68/70) in DES group vs 98.6%(69/70) in DCB group, P=0.185］. During follow-up, there was no significant difference in the incidence of MACE among PTCA group, DES group and DCB group ［20.0%(14/70) vs 17.1%(12/70) vs 8.6%(6/70)］(P=0.147). In terms of safety, the incidence of bleeding events was lower in PTCA group ［10.0%(7/70)］, and no in-stent thrombosis occurred. Multivariate Cox regression analysis showed that age (per 1-year increase), diabetes mellitus, acute coronary syndrome, lesion type (B2/C type) and target lesion vessel being left anterior descending artery were risk factors for MACE (all P<0.05). Conclusion In real-world clinical practice, in a propensity score-matched cohort of coronary heart disease patients, PTCA alone, as a representative of the "intervention without implantation" concept, shows favorable application value in specific lesions. Its surgical success rate is comparable to that of DES and DCB, and it has safety advantages of lower bleeding risk and zero in-stent thrombosis. Revascularization strategies should be reasonably selected according to lesion characteristics and individual patient conditions, and PTCA remains an important treatment option for specific populations.