药物洗脱支架与切割球囊预扩张后置入金属裸支架治疗前降支开口病变的近、远期临床疗效比较

Efficacy comparison between drug-eluting stents versus cutting balloon angioplasty followed by bare metal stents for the treatment of ostial lesions of the left anterior descending coronary artery

目的探讨药物洗脱支架（DES）治疗前降支开口病变的近、远期临床疗效，并与早期应用切割球囊预扩张后（CBA）置入金属裸支架（BMS）的近、远期临床疗效进行比较。方法自2003年11月至2005年5月采用DES对51例连续前降支开口病变的患者进行介入治疗，选自2000年5月至2003年11月应用CBA＋BMS治疗前降支开口病变的连续50例患者作为对照组，要求所有患者在介入治疗后6—8个月进行冠状动脉造影复查，DES组与CBA＋BMS组患者分别完成了2年和4年的临床随访。结果在DES组中1例于住院期间发生急性心肌梗死，住院期间主要不良心脏事件（MACE）发生率为1．96％（1／51），29例完成了6—8个月的冠状动脉造影复查，再狭窄发生率为10．3％（3／29）。在2年临床随访中1例死亡，靶病变重建4例，MACE发生率为9．8％（5／51）。在CBA＋BMS组中住院期间无心脏事件，28例完成了6—8个月的冠状动脉造影复查，再狭窄发生率为17．9％（5／28）。2年临床随访中1例死亡，行靶病变重建5例，MACE发生率为12％（6／50）。结论在2年的临床随访中，支架内再狭窄、MACE发生率两组比较差异均无统计学意义，研究结果提示无论是采用DES还是CBA＋BMS治疗前降支开口病变均有良好的近、远期疗效。

Objective To compare the short and long-term clinical and angiographic outcomes of drug-eluting stents （DES） versus cutting balloon angioplasty followed by bare metal stents （ CBA ＋ BMS） for the treatment of ostial lesions of the left anterior desending coronary artery （LAD）. Methods A total of 51 consecutive patients with LAD ostial lesions were treated by DES and all patients had completed 2-year clinical follow-up, 50 consecutive patients with LAD ostial lesions treated by CBA ＋ BMS and followed up for 2 years prior to the DES era （ May 2000 to November 2003 ） served as control group. Results In DES group, one patient experienced acute myocardial infarction （AMI） during hospitalization, the in-hospital major adverse cardiac event （MACE） was 1.96% （ 1/51 ）, angiography follow-up data at 6-8 months were available in 29 patients and the in-DES restenosis was 10. 3% （3/29）, at 2-year clinical follow-up, 1 patient died, 4 patients received target lesion revascularization. Total MACE rate was 9.8% （5/51）. In CBA ＋ BMS group, there was no in-hospital death and AMI. Angiographic follow-up at 6-8 months was completed in 28 cases and in-stent restenosis rate was 17.9% （5/28）. During 2-year follow-up, there was no death and AMI and 6 patients underwent target lesion revascularization. MACE rate was 12% （6/50） in this group. Conclusion This study showed that both clinical and angiographic outcomes were comparable between DES and CBA ＋ BMS treated patients with LAD ostial lesions during the 2-year follow up period.