摘要
背景:以支架为基础的冠状动脉介入治疗长病变时,预后仍相对不理想。本研究比较西罗莫司洗脱支架(SES)和紫杉醇洗脱支架(PES)治疗冠状动脉长病变的疗效。方法和结果:进行一项随机、多中心、前瞻性研究,
BACKGROUND-Outcomes remain relatively unfavorable for stent-based coronary intervention of lesions with long diseased segments. This study compared sirolimus-eluting stents(SES)and paclitaxel-eluting stents(PES) for long coronary lesions. METHODS AND RESULTS -The present randomized,multicenter,prospective study compared the use of long(≥32 mm) SES with PES in 500 patients with long(≥25 mm) native coronary lesions. The primary end point of the trial was the rate of binary in-segment restenosis according to follow-up angiography at 6 months. The SES and PES groups had similar baseline characteristics. Lesion length was 33.9±11.6 mm in the SES group and 34.5±12.6 mm in the PES group(P=0.527). The in-segment binary restenosis rate was significantly lower in the SES group than in the PES group(3.3%versus 14.6%; relative risk 0.23; P< 0.001). In-stent late loss of lumen diameter was 0.09±0.37 mm in the SES group and 0.45±0.55 mm in the PES group(P< 0.001). In patients with restenoses,a pattern of focal restenosis was more common in the SES group than in the PES group(100%versus 53.3%,P=0.031). Consequently,SES patients had a lower rate of target-lesion revascularization at 9 months(2.4%versus 7.2%,P=0.012). The incidence of death(0.8%in SES versus 0%in PES,P=0.499) or myocardial infarction(8.8%in SES versus 10.8%in PES,P=0.452) at 9 months of follow-up was not statistically different between the 2 groups. CONCLUSIONS-For patients with long native coronary artery disease,SES implantation was associated with a reduced incidence of angiographic restenosis and a reduced need for target-lesion revascularization compared with PES implantation.
