重叠药物洗脱支架术治疗冠状动脉长病变的临床疗效

Clinical effects of overlapping drug-eluting stent for treating long segmental lesions

目的评估重叠药物洗脱支架治疗冠状动脉长病变的疗效。方法47例患者53处长病变(≥30 mm)接受重叠冠脉药物洗脱支架术治疗(DES组),47例51处病变接受重叠金属裸支架患者作为对照组(BMS组)。比较两组临床情况、造影及介入治疗特征、临床和造影随访结果。结果两组介入治疗前临床情况和冠脉造影结果无显著差异。DES组植入支架较多,病变长度、支架覆盖总长度大于对照组,且血管内径小于BMS组。DES组复发胸痛者显著少于对照组(6%和38%,P<0.01),DES术后支架内晚期管腔丢失显著低于对照组[(0.1±0.03)mm和(1.1±0.41)mm,P<0.01],支架内再狭窄和靶血管再次血运重建率显著低于对照组(4.3%和34.0%;6.4%和44.7%,P<0.01),严重心脏不良事件发生率显著降低(6%和45%,P<0.01)。结论与金属裸支架相比,重叠药物洗脱支架术治疗冠状动脉超长病变能显著降低支架内再狭窄率、靶血管再次血运重建率及严重心脏不良事件发生率。DES治疗冠脉超长病变安全有效。

Objective To evaluate the efficacy of overlapping drug-eluting stent （DES） for treating long segmenal coronary arterial lesions. Methods Forty-seven patients with de novo coronary lesions more than 30 mm in length underwent overlapping drug-eluting stent therapy （DES group） were matched with the other forty-seven patients receiving bare-metal stents （BMS group）. Clinical characteristics, angiographic features and follow-up results were compared between the two groups. Results Baseline clinical and angiographic findings in the two groups were similar. Patients in DES group received more stents with longer length of lesions and the total length of stented vessels, and smaller comparative vascular diameters than thoes of BMS group. During the follow-up period, patients in DES group had lower recurrence rate of chest pain （6% vs. 38%, P 〈 0.01 ） .Angiographic follow-up showd that the late lumen loss in DES group was significantly less than that in BMS group [ （0.1 ± 0.03） mm vs. （1.1 ± 0.41 ） mm, P 〈 0.01 ]. In-stent restenosis and target vessel revascularization were lower in DES group （4.3 % vs. 34.0 % ;614% vs. 44.7% respectively, P 〈 0.01 ） ,and MACE rate was also lower during follow-up in DES group （6% vs. 45%, P 〈 0.01 ）. Conclusions Overlapping drug-eluting stent for treating long segmental coronary arterial lesions is safe and effective, with significantly reducing in-stent restenosis rate and MACE rate.