紫杉醇药物涂层支架治疗左前降支病变临床研究

Outcomes of paclitaxel-eluting stent and bare-metal stent implantation in patients with stenosis of the left anterior descending coronary artery

目的：探讨紫杉醇药物涂层支架（PES）治疗冠状动脉左前降支（LAD）病变的即刻疗效及预后。方法：2003年2月～2005年3月在本院造影证实连续LAD单支病变患者94例，共107处病变，按常规行经皮冠状动脉成形术加支架置入术，分析患者临床、X线影像学特征及手术成功率，并行随访。结果：94例患者中，29例置入PES，65例置入金属裸支架（BMS），手术成功率100％。病变弥漫性30例（31．9％），位于近段52例（55．3％），中段12例（12．8％）。全部患者均完成术后6个月的随访并行造影复查。PES组术后6个月时造影复查2例（6，9％）发生再狭窄；BMS组1例1个月内因急性前壁心梗死亡，6个月时造影复查21例（32．3％）发生再狭窄。结论：PES置入治疗冠状动脉LAD病变安全有效，术后心源性猝死及非Q波性心肌梗死发生率与置入BMS者相似，支架内再狭窄发生率明显降低，因再狭窄需冠脉搭桥率也显著降低，术后6个月再狭窄率与文献报道冠脉搭桥术相近。

Objectives To evaluate the immediate and mid-term results of paclitaxel-eluting stent for left anterior descending coronary artery. Methods From February 2003 to March 2005,94 cases undergoing diagnostic coronary angiography and proven to have left anterior descending coronary artery disease had been treated with paclitaxel-eluting stents or bare-metal stents. Clinical characteristics, angiographic results, success rate, severe complications and the results of following up were analyzed respectively. Results The success rate of the procedure was 100%. 29 cases implanted with paclitaxel-eluting stents,65 cases implanted with bare-metal stents. The patients with LAD lesions were well-matched into the 2 groups,including 31.9% diffuse disease （30 cases）,55.3% proximal disease （52 cases） and 12.8% middle disease （12 cases）. At six month,binary restenosis rates were 32.3% and 6.9% in BMS and PES group,respectively （P =0. 004）. 1 case implanted with BMS died of acute anterior wall infarction. Conclusion Compared to bare-metal stents,implantation of paclitaxel-eluting stents in LAD lesions is safe,and reduces angiographic restenosis one year. Notably, the need for bypass graft surgery due to restenosis and target lesion revascularization and target vessel revascularization is reduced after TAXUS stent implantation in LAD lesions .