关键词: 药物涂层球囊,  ,  , 冠心病,  ,  , 靶血管再狭窄,  ,  , 危险因素,  ,  , 预测模型

Abstract:

Objective　To approach the risk factors of target vessel restenosis after drug-coated balloon (DCB) angioplasty in patients with coronary artery disease, and develop a predictive model. Methods　A total of 108 CAD patients admitted to Ankang Central Hospital from January 2020 to March 2024 was selected as the study objects. All patients had underwent DCB angioplasty. Coronary angiography was used to evaluate restenosis of the target vessel six months after the operation. The patients were divided into a stenosis group (30 cases)and a non-stenosis group (78 cases). In the stenosis group, there were 18 males and 12 females, aged (64.30±6.10) years. In the non-stenosis group, there were 42 males and 36 females, aged (63.15±6.58) years. Clinical data, preoperative laboratory results, echocardiography findings and intraoperative coronary angiography characteristics were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Multivariate logistic regression analysis was performed to explore independent risk factors for target vessel restenosis. R software and rms packages were used to construct the nomogram model. The predictive efficacy of the model for target vessel restenosis in patients with coronary heart disease after DCB formation was analyzed by using calibration curve, receiver operating characteristic curve (ROC) and decision analysis curve. Results　The proportions of smoking and diabetes in the stenosis group were higher than those in the non-stenosis group, the proportion of using pre-dilated balloons was lower than that in the non-stenosis group, the length of target vascular lesions was longer than that in the non-stenosis group, the postoperative residual stenosis rate and the levels of low-density lipoprotein cholesterol (LDL-C) and cystatin C (CysC) were higher than those in the non-stenosis group, the levels of matrix metalloproteinase inhibitor-1 (TIMP-1) and secreted frizzled-related protein 5 (SFRP-5) were lower than those in the non-stenosis group (all P<0.05). The results of multivariate logistic regression analysis indicated that smoking (OR=5.697, 95%CI: 1.332-24.359), diabetes (OR=5.169, 95%CI: 1.241-21.532), preoperative high LDL-C levels (OR=5.163, 95%CI: 1.271-20.976), low TIMP-1 levels (OR=0.151, 95%CI: 0.023-0.990), low SFRP-5 levels (OR=0.149, 95%CI: 0.025-0.892), no use of pre-dilated balloons during the operation (OR=0.308, 95%CI: 0.104-0.910), and high residual stenosis rate after the operation (OR=4.901, 95%CI: 1.014-23.673) were all independent risk factors for target vessel restenosis (all P<0.05). Based on the results of multivariate logistic regression analysis, a nomogram model influencing target vessel restenosis in patients with coronary heart disease after DCB angioplasty was constructed. The results showed that coronary heart disease patients who smoked, had diabetes, had high preoperative LDL-C levels, low TIMP-1 levels, low SFRP-5 levels, did not use pre-dilated balloons during the operation, and had a high postoperative residual stenosis rate had a higher risk of target vessel restenosis after DCB angioplasty. The area under the curve of the nomogram model was 0.981, with a sensitivity of 96.67% and a specificity of 92.31%. Conclusion　Smoking, diabetes, high preoperative LDL-C levels, low TIMP-1 levels, SFRP-5 levels, no use of pre-dilated balloons during the operation, and high postoperative residual stenosis rate are independent risk factors for target vessel restenosis after drug-coated balloon angioplasty.

Key words: Drug-coated balloon,  , Coronary artery disease,  , Target vessel restenosis,  , Risk factors,  , Predictive model