药物涂层支架在冠状动脉易再狭窄病变的应用价值

Clinical value of drug-eluted stents in lesions at high risk of restenosis

目的评估药物涂层支架(DES)对防治冠状动脉高危病变和糖尿病患者支架植入术后再狭窄的价值。方法126例接受雷帕霉素或紫杉醇DES植入术的冠心病患者为DES组,至少具备下列情况之一糖尿病或糖耐量异常;前降支病变;小血管病变(直径≤2.5mm);靶病变再狭窄。同期选择年龄、性别和狭窄程度等因素相匹配的146例行普通支架(BMS)术的冠心病患者为BMS组,比较两组住院和随访期间的心绞痛、非致死性心肌梗死、心源性死亡和靶病变血运重建(TLR)等主要心脏事件(MACE)。结果DES组合并糖尿病、左前降支植入支架数均明显高于BMS组(P<0.01);DES平均内径较BMS显著为小(P<0.01)。MACE发生率DES组(6例,4.8%)显著低于BMS组(40例,27.4%)(P<0.01)。结论DES能有效地降低冠状动脉高危病变和合并糖尿病患者冠状动脉支架内再狭窄率,进而减少MACE的发生率。

Objective The purpose of this study was to evaluate the results of drug-eluted stents（DES） in the lesions at high risk of restenosis（diabetes mellitus or impaired glucose tolerance, vessel diameter≤2. 5 mm, disease of the left anterior descending and restenosis） after percutaneous coronary intervention（PCI）. Methods Two hundred seventy-two patients with coronary artery disease （CAD） were assigned to bare metal stents（BMS） group（146 cases, 227 stents） and DES group（126 cases,162 stents） according to these well-matched factors of age, sex and stenosis degree during the same time period. The clinical, coronary artery lesion chractristics and major adverse cardiac event （MACE） rate during in-hospital and follow up periods were compared. Results The number of CAD with diabetes and stent implanted in the left anterior desending in DES group was greater than that in BMS group（P〈0. 01）. The mean diameter of DES was smaller than that of BMS（P〈0.01）. The incidence of MACE was reduced from 27.4%（40 cases） in BMS group to 4. 8%（5 cases） in DES group （P〈0.01）. Conclusion DES in the lesions at high risk of restenosis can reduce the occurrence of restenosis and MACE compared to the conventinal stents.