药物洗脱支架置入治疗不同时期冠状动脉支架内再狭窄对比研究

Comparison of drug eluting stent for treatment of early and late in-stent restenosis

目的比较药物洗脱支架(DES)治疗早期(≤1年)、晚期(>1年)支架内再狭窄病变(ISR)患者的长期临床疗效。方法收集2008年10月至2011年12月在北京安贞医院因ISR接受DES置入治疗并完成临床随访的患者资料,根据DES术后发生ISR的时间是否大于1年分为早期ISR组与晚期组。比较两组组患者术后1年的主要不良心血管事件[MACE,包括全因死亡、心肌梗死(MI)和靶病变再次血运重建(TLR)]。结果早期ISR组入选患者80例,晚期ISR组入选患者124例。早期ISR组不稳定型心绞痛发生率明显低于晚期ISR组,差异有统计学意义(27.5%对63.7%,P<0.01);其余基线资料差异无统计学意义(P>0.05)。两组在病变部位、病变类型、病变长度方面比较差异均无统计学意义(P>0.05)。早期ISR组MACE发生率明显高于晚期ISR组(30%对15.3%,P<0.01),其中早期ISR组TLR明显高于晚期ISR组,差异有统计学意义(26.3%对12.1%,P<0.01)。结论 DES治疗ISR患者安全有效,但治疗早期ISR组病变TLR发生率高于晚期ISR组。

Objective Compare the efficiency and safety of drug eluting stent （DES） for treatment of early and late in stent restenosis（ISR）. Methods Patients treated with DES for ISR and de novo lesions in Beijing Anzhen Hospital between October 2008 and December 2011 were followed up for 1 year. All lesions were divided into early and late ISR group. Major adverse cardiovascular events （MACE） including all-cause death, myocardial infarction （MI） and clinical target lesion revascularization （TLR） were the primary endpoints. Results The study population consisted of 80 patients in early ISR group and 124 patients in late ISR group. Baseline clinical and angiographic parameters were comparable between the two groups. The rate of TLR in early ISR group was higher than that in late ISR group （26. 3% to 12. 1% ,P 〈 0. 05 ）, contributing to higher MACE in early ISR group（ 30.0% vs 15.3 % , P 〈 0.01 ）. Condusion DES implantation is safe and effective for treatment of ISR lesions ,but the rate of TLR for treatment of early ISR lesions is higher compared to treatment of late ISR legions.