Clinical Efficacy Of Drug-Coated Balloon And Drug-Eluting Stent In The Treatment Of Coronary Heart Disease Complicated With Chronic Renal Disease In Stage 1-4 Non-Dialysis Patients

Objective:Comparison of the efficacy and safety of drug-coated balloon and drug-eluting stent in patients with coronary heart disease complicated with chronic kidney disease in stage 1-4 non-dialysis patients and analysis of risk factors after percutaneous coronary intervention.Methods:A total of 2939 patients who underwent coronary angiography intervention in the Department of Cardiology,people’s Hospital of Guangxi Zhuang Autonomous region from January 2020 to December 2021 were selected.According to the standard of discharge,553 patients were included in the retrospective analysis.According to the creatinine clearance rate,the patients were divided into chronic kidney disease group and non-chronic kidney disease group,and each group was divided into drug-coated balloon group and drug-eluting stent group according to the selected interventional methods.By comparing the incidence of acute events during the follow-up period and the reconstruction rate of target vessel stenosis one year later,we can determine whether drug-coated balloon is more effective and safe than drug-eluting stent in patients with chronic renal disease.The statistically significant indexes in univariate COX regression analysis and the factors related to postoperative prognosis of coronary heart disease(such as sex,diabetes,hypertension,blood lipids and so on)were included in multivariate COX regression analysis to explore the risk factors of postoperative poor prognosis.Results:Except for 1 patient who died of coronary artery perforation and cardiac tamponade during operation,3 cases died of postoperative acute heart failure and cardiogenic shock.In drug-coated balloon group,there were 3 patients with drug-coated balloon had severe dissection and needed stent implantation,2 patient with mild dissection.All other patients were operated successfully,and no adverse events such as acute myocardial infarction occurred after operation.By comparing the baseline data of chronic kidney disease and non-chronic kidney disease groups,we can see that there are differences in age,body mass index,hypertension,diabetes,previous interventional history,diagnosis of Non-ST segment elevation myocardial infarction and Unstable angina pectoris.Patients in chronic kidney disease group are older and more patients with hypertension or diabetes,while patients in non-chronic kidney disease patients have higher body mass index and more patients with Unstable angina pectoris.By comparing the surgical details between the two groups,we can see that there is no significant difference in the type of target vessels,the number of diseased vessels and the approach path between the chronic kidney disease group and the non-chronic kidney disease group.Results of one-year follow-up showed significant differences in the incidence of major adverse cardiovascular events between chronic kidney disease and non-chronic kidney disease groups(P <0.001).The incidence of endpoint events was significantly higher in the chronic kidney disease group(33.5%)than in the non-chronic kidney disease group(18.9%).Among the patients with coronary heart disease complicated with chronic kidney disease,there were more patients with previous myocardial infarction in the drug balloon group and more patients with hypertension in the drug stent group,and there was no significant difference in others.Compared with the drug stent group,the rate of non-fatal myocardial infarction in the drug balloon group was significantly higher than that in the drug stent group,and there was no significant difference in major cardiovascular adverse events,target vessel revascularization and bleeding.Through univariate COX regression analysis of drug-coated balloon group,it was found that patients with chronic kidney or diabetes disease were associated with major cardiac adverse events.Multivariate COX regression analysis confirmed that it was an independent risk factor for postoperative adverse events.Conclusion:1.This study showed that the long-term prognosis of non-dialytic coronary heart disease patients with stage 1-4 chronic kidney disease after interventional therapy was lower than that of patients with normal renal function.2.In patients with non-dialysis coronary heart disease in stage 1-4 with chronic kidney disease,compared with patients treated with drug-eluting stent,the incidence of non-fatal myocardial infarction in drug-coated balloon group was higher than that in drug-eluting stent group 1 year after operation.There was no significant difference in other outcome events between the two groups,the curative effect was the same,and there was no obvious advantage in bleeding.3.Chronic kidney disease or diabetes mellitus is an independent risk factor for poor prognosis in patients with coronary heart disease.