直接冠脉支架植入与球囊预扩张后植入疗效比较

目的比较分析经皮冠状动脉介入治疗(PCI)过程中支架直接植入(DS)与经球囊预扩张后支架植入(B+S)两种方法的操作过程及近期与长期效果。方法对165例患者183处病变有选择的血管病变进行非随机分组,DS组75例患者87处病变,B+S组90例患者96处病变。结果DS组直接支架成功率95．5％,4处钙化较重病变直接支架通过困难,后经球囊预扩张后成功植入支架;B+S组成功率为99％, 一处支架植入未成功而放弃。术后两组住院期间均无心脏不良事件发生,术后两组平均随访时间均为 (12±8)个月,DS组与B+S组术后心脏不良事件发生率分别为5．1％及4．6％(P>0．05);手术操作时间及X线曝光时间DS组分别为(43±10)min、(56±12)min,比B+S组的(11±5)min及(14±6)min明显长(P<0．01);单纯PCI过程所用造影剂量DS组为(116+35)ml比B+S组的(129±41)ml明显减少(P<0．01)。结论对大多数血管病变而言,直接支架植入是安全可行的,但成功率稍低;与常规经球囊预扩张支架植入方法相比。两组PCI术后心脏不良事件发生率无明显差异,而直接支架植入可减少造影剂用量、缩短手术时间及X 线曝光时间。

Comparative study of coronary stent implantation with/without balloon predilation

Objective To compare long-term clinical outcomes of direct coronary stent implantation with/without balloon predilation (DS or B+S).Methods 165 patients with 183 vessel lesions were divided two groups: DS group, 75 patients who were treated with DS and B+S goup, 90 patients treated with B+ S.The obtained data was analysed.Results Success rate of DS group was 95.4%,with 4 cases requiring crossover to predilation and success rate of B+S group was 99%.Procedure success rates have significant difference (95.4% vs 99%,P<0.05) between the DS and B+S groups. The occurence rate of major adverse cardiac events (MACE) of both groups post-procedure during in-hospital was 0%. The mean clinical follow-up duration of both groups was 12 (8 months,the MACE occurence rates post-procedure were not significantly different between DS and B+S groups (5.1% vs 4.6%,P>0.05). The procedure time (43± 10min vs 56±12min,P<0.01) and X-ray exposure time (11±5min vs 14±6min,P<0.01) were significantly shorten in the DS group,and there was a decreased utilization of contrast agent in the DS group. Conclusions Direct coronary stent implantation without balloon predilation is safe and feasible for majority lesions.Comparing with the B+S group,DS is associated with decreased utilization of contrast agent and shorter procedure time and X-ray exposure time.