紫杉醇支架和金属裸支架治疗弥漫长病变的效果比较研究

Comparison of Paclitaxel-Eluting Stent With Bare-Metal Stent in Treating Complex and Diffuse Coronary Lesions

目的:比较采用紫杉醇药物洗脱支架(PES)和金属裸支架(BMS)治疗弥漫长病变的近期和远期预后。方法:患者为我院接受置入单个长度>25 mm紫杉醇药物洗脱支架(PES组,n=68)或金属裸支架(BMS组,n= 132)治疗并且进行冠状动脉造影随访的200例患者。患者在支架术后6个月后接受冠状动脉造影随访。结果:在患者临床基本条件方面PES组较BMS组2型糖尿病患者更多,有显著性差异;在病变基本条件方面,PEs组术前参考血管直径明显小于BMS组,支架长度大于BMS组。6个月后的随访结果显示支架内再狭窄率PES组小于BMS组(P=0．002)。晚期腔径丢失BMS组明显大于PES组(P<0．001)。靶病变血管重建率(TLR)PES组有好于BMS组[10(13．5％)vs．35(24．3％),P=0．062]的趋势,但是没有达到统计学差异。结论:本研究发现对于弥漫长病变的治疗,PES较BMS明显减少晚期腔径丢失和支架再狭窄率,靶病变血管重建率两组并没有差异,临床效果尚需进一步观察。

Objective： To compare paclitaxel-eluting stent （PES） with bare-metal stent （BMS） in treating complex and diffuse coronary lesions. Methods： Two hundred consecutive patients with complex and diffuse coronary lesions were enrolled in our study from April 2004 to August 2005, who were treated with more than 25 mm long PES or BMS. All patients received medical treatment. Aspirin 300 mg and clopidogrel 75 mg once daily were given for 6 months after procedure. The patients were followed up at the end of treatment. Results： The study population was consisted of 200 patients （185 men, and 15 women）, who had 218 target coronary lesions. There were 88.1% of C type lesion. The average reference vessel diameter was 2.97 ± 0.49 mm. The average stent length of per lesion was 36.82 ± 11.55 mm. There were 40.4% of lesions treated with overlapping stent. Patients who had received PCI in PES group were more than those in BMS group, but referenced vessel diameter of PES group was shorter than that of BMS group （2.81 ±0.34 mm,3.04 ±0.49 mm,P 〈0.001 ） at baseline. The average stent length of per lesion in PES group was longer than that of BMS group（39.57 ± 14.74 mm,35.41±9.26 mm,P =0. 029）. At 6 months after procedure, restenosis rate in PES group was less than that BMS group （ 14 [ 18.9% ] vs 57 [ 39.6% ], P = 0. 002）. There was less in-segment lumen late loss in PES group than in BMS group（0.63 ± 0.67 mm, 1.05± 0.73 mm, P 〈 0. 001 ）. PES had no obvious superiority in target lesion revasculization over BMS （ 10[ 13.5% ] vs 35[24.3% ], P =0.062）. Conclusions： Implantation of PES in patients with complex and diffuse coronary lesion is relatively safe and had much beneficial clinical outcomes compared with BMS.