药物洗脱支架和裸支架在病变静脉桥血管中远期丢失的比较(英文)

Late lumen loss of drug eluting stents versus bare mental stents for saphenous vein graft intervention

背景:尽管多项研究证实药物洗脱支架能在病变静脉桥血管中应用,但作者所查目前报道资料较少。目的:回顾性观察药物洗脱支架和裸支架在病变静脉桥血管治疗中管腔晚期丢失和心脏事件发生的关系。设计、时间及地点:分组对照,随访观察,于2002-01/2007-02在北京市通州区潞河医院和北京市安贞医院进行。对象:选择静脉桥血管患者97例,其中药物洗脱支架治疗50例,裸支架治疗47例。方法:行标准的经皮支架置入,置入后即刻进入临床随访,置入后12个月复查桥血管造影。主要观察指标:管腔晚期丢失,心脏事件(死亡,心肌梗死,靶血管和/或靶血管重建)。结果:两组性别、年龄、桥血管年龄、合并症等基线资料比较,差异无显著性意义(P>0.05),具有可比性。①药物洗脱支架组50例患者,在59处病变中置入了71枚药物支架,裸支架组47例患者在59处病变中置入了62枚裸支架。药物洗脱支架组操作成功率为94.0%,裸支架组为93.6%(P=0.43)。②12个月临床随访,药物洗脱支架组心脏事件发生率明显低于裸支架组(12.0%vs.29.8%,P=0.03)。共有54例患者进行了造影随访,其中药物洗脱支架组26例,裸支架组28例,药物洗脱支架组管腔晚期丢失明显低于裸支架组[(0.32±0.65)mmvs.(0.79±1.23)mm,P=0.01]。药物洗脱支组架靶血管重建率为6.0%,裸支架组为19.1%(P=0.05)。③Cox回归分析表明12个月随访时心脏事件的独立预测因子是裸支架(OR:2.86;CI:0.98to8.34;P=0.05),每一处病变所置入的支架数目(OR:2.92;CI:1.25to6.82;P=0.01)和糖尿病(OR:2.37;CI:0.95to5.88;P=0.064)。结论:和裸支架相比,药物洗脱支架治疗病变静脉桥血管可以明显地降低晚期管腔丢失,从而减少心脏事件的发生。

BACKGROUND： Drug eluting stents （DESs） has been applied in treatment of saphenous vein grafts, but few reports are present. OBJECTIVE： To retrospectively compare the late loss and major adverse cardiac events （MACE） between DES and bare mental stents （BMS） in patients with diseased saphenous vein grafts. DESIGN, TIME AND SETTING： The experiment, a grouping control study and follow-up observation, was performed from January 2002 to February 2007 in Beijing Luhe Hospital and Beijing Anzhen Hospital. PARTICIPANTS： Ninety-seven consecutive patients with saphenous vein graft lesions were treated with DESs （DES group, n=50） or BMSs （BMS group, n=47）. METHODS： All patients underwent percutaneous coronary implantation and received clinical follow-ups immediately. They were scheduled to undergo 12-month coronary angiography. MAIN OUTCOME MEASURES： The cardiac events including death, myocardial infarction, target lesion and/or target vessel revascularization. Late lumen loss was recorded and compared between the two groups. RESULTS： There were no significant differences on the gender, age, history of bridge vessels and complication between the two groups （P 〉 0.05）. A total of 97 patients with 118 lesions localized in 105 diseased saphenous vein grafts were included： 50 patients received 71 DESs for 59 lesions, whereas 47 patients received 62 BMSs for 59 lesions. Procedural success was achieved in 94.0% of patients in the DES group and 93.6% in BMS group （P=0.43）. At 12 months, the cumulative incidence of MACE was significantly lower in DES group than in BMS group （12.0% vs. 29.8%, P=0.03）. Angiographic follow-up was available for 54 patients, 26 patients in DES group and 28 in BMS group. Late lumen loss was significantly reduced in DES group [（0.32±0.65） mm vs. （0.79±1.23） mm, P=0.01]. The DES group had a significantly lower incidence of target lesion revascularization compared with BMS group （6.0% vs. 19.1%, P=0.05）. By Cox regression analysis, independent predictors for MACE at 12-month follow-ups were diabetes （OR： 2.37; CI： 0.95 to 5.88; P=0.064）, BMS （OR： 2.86; CI： 0.98 to 8.34; P=0.05）, and stent per lesion （OR： 2.92; CI： 1.25 to 6.82; P=0.01）. CONCLUSION： DES is superior to BMS in diseased saphenous vein grafts, and it can significantly reduce late lumen loss and MACE.