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Abstract：
BACKGROUND: The hybrid strategy of a combination of drug-eluting stent (DES) and drug-coated balloon (DCB) is promising for the treatment of de novo diffuse coronary artery disease (CAD).
OBJECTIVE: To investigate the efficacy and functional results of hybrid strategy.
METHODS: This case series study included patients treated with a hybrid approach for de novo diffuse CAD between February 2017 and November 2021. Postprocedural quantitative flow ratio (QFR) was used to evaluate the functional results. The primary endpoint was procedural success rate. The secondary endpoints were major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction (MI) (including peri-procedural MI), and target vessel revascularization.
RESULTS: A total of 109 patients with 114 lesions were treated. DES and DCB were commonly used in larger proximal segments and smaller distal segments, respectively. The mean QFR value was 0.9 ± 0.1 and 105 patients (96.3%) had values >0.8 in all the treated vessels. Procedural success was achieved in 106 (97.2%) patients. No cases of cardiac death were reported at a median follow-up of 19 months. Spontaneous MI occurred in three (2.8%) patients and target vessel revascularization in six (5.5%) patients. Estimated 2-year rate of MACE excluding peri-procedural MI was higher in the group with lower QFR value (12.1 ± 5.7% vs. 5.6 ± 4.4%, log-rank p = .035) (cut-off value 0.9).
CONCLUSIONS: Hybrid strategy is a promising approach for the treatment of de novo diffuse CAD. Postprocedural QFR has some implications for prognosis and may be helpful in guiding this approach.
OBJECTIVE: To investigate the efficacy and functional results of hybrid strategy.
METHODS: This case series study included patients treated with a hybrid approach for de novo diffuse CAD between February 2017 and November 2021. Postprocedural quantitative flow ratio (QFR) was used to evaluate the functional results. The primary endpoint was procedural success rate. The secondary endpoints were major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction (MI) (including peri-procedural MI), and target vessel revascularization.
RESULTS: A total of 109 patients with 114 lesions were treated. DES and DCB were commonly used in larger proximal segments and smaller distal segments, respectively. The mean QFR value was 0.9 ± 0.1 and 105 patients (96.3%) had values >0.8 in all the treated vessels. Procedural success was achieved in 106 (97.2%) patients. No cases of cardiac death were reported at a median follow-up of 19 months. Spontaneous MI occurred in three (2.8%) patients and target vessel revascularization in six (5.5%) patients. Estimated 2-year rate of MACE excluding peri-procedural MI was higher in the group with lower QFR value (12.1 ± 5.7% vs. 5.6 ± 4.4%, log-rank p = .035) (cut-off value 0.9).
CONCLUSIONS: Hybrid strategy is a promising approach for the treatment of de novo diffuse CAD. Postprocedural QFR has some implications for prognosis and may be helpful in guiding this approach.
摘要：
背景：药物洗脱支架（DES）和药物涂层球囊（DCB）组合的混合策略有望用于从头弥漫性冠状动脉疾病（CAD）的治疗。
目的：探讨混合策略的疗效和功能效果。
方法：本病例系列研究纳入了2017年2月至2021年11月间采用混合方法治疗从头弥漫性CAD的患者。术后定量流量比（QFR）用于评估功能结果。主要终点是手术成功率。次要终点是主要不良心血管事件（MACE），包括心脏死亡，心肌梗死（MI）（包括围手术期MI），和目标血管血运重建。
结果：共治疗109例患者，共114个病灶。DES和DCB通常用于较大的近端段和较小的远端段，分别。平均QFR值为0.9±0.1,并且105名患者(96.3%)在所有治疗的血管中具有>0.8的值。106例（97.2%）患者手术成功。在19个月的中位随访中，没有报告心脏死亡病例。3例（2.8％）患者发生自发性MI，6例（5.5％）患者发生靶血管血运重建。在QFR值较低的组中，不包括围手术期MI的估计2年MACE发生率较高（12.1±5.7％vs.5.6±4.4%,对数秩p=.035)(截止值0.9)。
结论：混合策略是治疗从头弥漫性CAD的一种有希望的方法。术后QFR对预后有一定影响，可能有助于指导这种方法。
目的：探讨混合策略的疗效和功能效果。
方法：本病例系列研究纳入了2017年2月至2021年11月间采用混合方法治疗从头弥漫性CAD的患者。术后定量流量比（QFR）用于评估功能结果。主要终点是手术成功率。次要终点是主要不良心血管事件（MACE），包括心脏死亡，心肌梗死（MI）（包括围手术期MI），和目标血管血运重建。
结果：共治疗109例患者，共114个病灶。DES和DCB通常用于较大的近端段和较小的远端段，分别。平均QFR值为0.9±0.1,并且105名患者(96.3%)在所有治疗的血管中具有>0.8的值。106例（97.2%）患者手术成功。在19个月的中位随访中，没有报告心脏死亡病例。3例（2.8％）患者发生自发性MI，6例（5.5％）患者发生靶血管血运重建。在QFR值较低的组中，不包括围手术期MI的估计2年MACE发生率较高（12.1±5.7％vs.5.6±4.4%,对数秩p=.035)(截止值0.9)。
结论：混合策略是治疗从头弥漫性CAD的一种有希望的方法。术后QFR对预后有一定影响，可能有助于指导这种方法。
