摘要
Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.
Objective： Although drug-eluting stent （DES） implantation is the primary treatment modality for bare-metal stent （BMS） in-stent restenosis （ISR）, little is known about the efficacy and safety profile of DES in the treatment of DES-ISR. The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR. Methods： Rates of major adverse cardiac events （MACE） were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR （56 BMS-ISR and 41 DES-ISR） from January 2004 to December 2008. Results： Baseline clinical and procedural characteristics were comparable, except that the DES used in the BMS-ISR group was longer and had a larger diameter. The length of follow-up was （28.60±1.96） and （20.34±1.54） months for the BMS-ISR and DES-ISR groups, respectively. One patient （1.8%） experienced non-cardiac mortality and one （1.8%） had target-vessel revascularization （TVR） in the BMS-ISR group. In the DES-ISR group, three patients （7.3%） died of sudden death with a documented acute ST-segment elevation myocardial infarction, and three suffered TVR （7.3%）. Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group （log rank test P=-0.047 and P=0.005, respectively）. In Cox regression analysis, DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors （compared with BMS-ISR, risk ratio （RR）=8.743, 95% confidence interval （CI） 1.54-49.54, P=0.014）. Switching to a different type of DES to treat DES-ISR did not improve the prognosis. Conclusion： DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.
基金
Project (No.08XD14026) supported by the Program of Shanghai Subject Chief Scientist,China
