药物洗脱支架治疗多支慢性完全闭塞冠脉病变的中期疗效观察

Mid-term treatment results of drug-eluting stent implantation for patients with multivessel chronic total coronary occlusion lesions

目的探讨药物洗脱支架(DES)对多支慢性完全闭塞病变(CTO)冠心病患者的中期疗效和临床意义。方法选取2002年11月～2005年6月成功完成的多支CTO经皮冠状动脉介入治疗(PCI)置入DES的89例冠心病患者作为DES组,对照组为2000年11月～2003年6月成功置入裸金属支架(BMS)的多支CTO冠心病患者70例。分析比较两组临床资料、病变特征、PCI结果和住院期间主要不良心脏事件(MACE),并记录出院后6个月临床随访时的MACE发生率。结果两组患者基础临床特征无统计学差异,仅DES组心肌梗死患者比例低于BMS组(29.2%vs45.7%);两组患者CTO靶血管分布和PCI治疗情况无统计学差异;与BMS组比较,DES组CTO特征中≥15mm的靶病变数、平均支架数及平均支架长度均较高,而平均支架直径较低。两组患者住院期间均未发生MACE事件;6个月后随访DES组靶病变再血管化、靶血管再血管化、累积MACE率和总再狭窄率均低于BMS组,差异有统计学意义。结论DES在多支CTO患者PCI治疗中有较好的应用前景。

Objective To evaluate mid-term clinical result of drug-eluting stent （DES） implantation for patients with multivessel chronic total coronary occlusion （CTO） lesions. Methods We analyzed 89 patients who underwent interventional revascularization in their multivessel CTO lesions with DES from November 2002 to June 2005 （DES group）. A control group was composed of 70 consecutive patients with multivessel CTO lesions treated with bare metal stents （BMS） from November 2000 to June 2003 （BMS group）. Results There were no significant differences in basic clinical manifestations and success rate of intervention procedures between DES and BMS group. At 6- month follow-up, the cumulative rate of major adverse cardiac events （MACE） was 14. 6% in the DES group and 28. 6% in the BMS group （P=0. 031）. The incidence of restenosis was 16.9% in the DES group and 34. 3% in the BMS group （P=0. 011）. The need for target vessel revascularization and target lesion revascularization in the DES group was significantly lower （9.0% vs 21.45, P= 0. 003, and 7. 9% vs 18. 6%, P=0. 043, respectively） compared with BMS group. Conclusion It is possible tO obtain an ideal mid-term clinical outcome in patients with multivessel CTO lesions by DES implantation.