PCI单独与联合PTCRA治疗冠心病的疗效分析*

Effects of coronary rotation combined with PCI on curative effect, vascular injury and MACE in CHD patients*

摘要:

目的 探讨冠状动脉腔内斑块旋磨术（PTCRA）联合经皮冠脉介入术（PCI）治疗冠状动脉粥样硬化性心脏病（CHD）患者的临床疗效及对患者血管损伤、远期再狭窄率的影响。方法 选取2014年7月— 2017年6月武汉亚洲心脏病医院实施PCI治疗的CHD患者107例进行回顾性分析。根据患者是否实施PTCRA分为PTCRA组62例（PCI联合PTCRA手术治疗），对照组45例（仅PCI治疗）。两组基础治疗措施保持一致，比较两组患者的临床疗效。结果 PTCRA组的置入支架数目、平均支架直径、平均支架长度与对照组比较，差异无统计学意义（P?>0.05）；PTCRA组的手术成功率98.39%与对照组95.56%比较，差异无统计学意义（P?>0.05）；两组术前的病变血管直径、血管狭窄率比较，差异无统计学意义（P?>0.05）；两组术后的病变血管直径、血管狭窄率比较，差异有统计学意义（P?<0.05），PTCRA组患者的病变血管直径大于对照组，血管狭窄率低于对照组；PTCRA组患者的血管损伤率6.45%与对照组的4.44%比较，差异无统计学意义（P?>0.05）；术后6个月PTCRA组患者的主要不良心血管事件（MACE）发生率6.45%与对照组20.00%比较，差异有统计学意义（P?<0.05）。患者2年心脏无病生存率为（71±7）%；患者2年靶血管血运重建率（TVR）为（19.3±7.0）%。结论 PCI联合PTCRA治疗CHD患者有利于降低手术后病变血管的狭窄率，降低术后MACE的发生率，同时不会增加术中血管损伤。

Abstract:

Objective To investigate the clinical efficacy of percutaneous coronary rotational atherectomy (PTCRA) combined with percutaneous coronary intervention (PCI) in the treatment of coronary heart disease (CHD) and its effect on vascular injury and long-term restenosis. Methods From July 2014 to June 2017, a total of 107 CHD patients who underwent PCI operation were retrospectively analyzed. Patients underwent PTCRA were divided into PTCRA group (62 patients), and the others were divided into the control group (45 patients). On the same basic treatment measures, the clinical efficacy of the two groups was compared. Results Compared with the control group, the number, rotational average diameter, average length of stents in PTCRA group were not statistically different (P?> 0.05). The success rate of PTCRA group was 98.39% compared with 95.56% of the control group, the difference was not statistically significant (P?>?0.05). The difference of preoperative lesion vessel diameter and vascular stenosis rate between the two groups was not statistically significant (P?>?0.05); after operation, the difference between the two groups was statistically significant (P?>?0.05). The diameter of diseased vessels in PTCRA group was larger than that in control group, and the rate of vascular stenosis was lower than that in control group; the vascular injury rate of PTCRA group was 6.45% compared with 4.44% of control group, the difference was not statistically significant (P?>?0.05); the incidence of major adverse cardiovascular events (MACE) was 6.45% in PTCRA group and 20.00% in control group at 6 months after operation, and the difference was statistically significant (P?