PCI治疗重症冠心病的安全性和远期疗效

Safety and long-term curative effect of percutaneous coronary intervention in treatment of severe coronary artery disease

目的探讨经皮冠状动脉介入治疗(PCI)重症冠心病的安全性和远期疗效。方法选取2014年1月~2016年12月于云南省丽江市人民医院收治的重症冠心病患者75例,其中男性42例,女性33例,年龄43~78岁,平均(56.82±7.27)岁。所有患者分为雷帕霉素洗脱支架组(SES组,54例)及金属裸支架组(BMS组,21例)。术后随访12~27个月,对比SES组和BMS组的支架内再狭窄发生率及靶病变血运重建(TLR)率。比较两组心血管事件发生情况,包括心血管死亡、心肌梗死、心力衰竭、卒中等。结果 75例患者中共86处病变,共成功置入107枚支架。SES组置入72枚支架,平均直径为(3.01±0.32)mm,平均长度为(23.10±4.32)mm;BMS组置入35枚支架,平均直径为(3.03±0.30)mm,平均长度为(22.43±4.26)mm。两组支架平均直径及平均长度比较差异无统计学意义(P均>0.05)。SES组发生心血管事件4例,发生率为7.4%,BMS组发生心血管事件6例,发生率为28.6%,两组心血管事件发生率比较差异有统计学意义(P<0.05)。随访12~27个月,结果显示BMS组支架内再狭窄发生率为47.6%,高于SES组的3.7%,差异具有统计学意义(P<0.05)。BMS组TLR率为33.3%,高于SES组的1.9%,差异具有统计学意义(P<0.05)。结论经皮冠状动脉介入治疗重症冠心病,雷帕霉素洗脱支架的远期效果和安全性要优于金属裸支架。

Objective To investigate the safety and long-term curative effect of percutaneous coronary intervention （PCI） in treatment of severe coronary artery disease （CHD）. Methods The patients with severe CHD （n=75, male 42, female 33, aged from 43 to 78 and average age=56.82±7.27） were chosen from the People＇s Hospital of Lijiang City of Yunnan Province from Jan. 2014 to Dec. 2016. All patients were randomly divided into sirolimus-eluting stent group （SES group, n=54） and bare metal stent group （BMS group, n=21）. The patients were followed up for 12-27 months, and the incidence of in-stent restenosis and target lesion revascularization rate （TLR） were compared between 2 groups. The incidence of major adverse cardiovascular events （MACE）, including cardiovascular death, myocardial infarction, heart failure and stroke, was compared between 2 groups. Results There were 86 lesions and 107 successfully implanted stents in 75 patients. There were 72 stents implanted with average diameter of （3.01±0.32） mm and average length of （23.10±4.32） mm in SES group, and 35 stents implanted with average diameter of （3.03±0.30） mm and average length of （22.43±4.26） mm in BMS group （all P〉0.05）. There were 4 cases of MACE （7.4%） in SES group and 6 （28.6%） in BMS group （P〈0.05）. The results of follow-up for 12-27 months showed that the incidence of in-stent restenosis was 47.6% in BMS group and 3.7% in SES group （P〈0.05）. TLR was 33.3% in BMS group and 1.9% in SES group （P〈0.05）. Conclusion The long-term curative effect and safety of SES are better than those of BMS in treatment of severe CHD with PCI.