不同SYNTAX评分冠心病患者置入不同药物洗脱支架对长期临床结局影响

Effect of different drug-eluting stents on long-term clinical outcomes in patients with coronary artery disease based on different SYNTAX score

目的探讨不同SYNTAX评分的冠心病患者置入生物可降解涂层药物洗脱支架(BP-DES)或永久涂层药物洗脱支架(DP-DES)后对长期临床预后的影响。方法选取I-LOVE-IT 2研究中置入BP-DES或DP-DES的2737例患者为研究对象。根据SYNTAX评分将患者分为A组(SYNTAX评分<7.0分,n=774)、B组(7.0分≤SYNTAX评分<13.5分,n=1046)、C组(SYNTAX评分≥13.5分,n=917)。本研究的主要终点事件为4年靶病变失败(TLF),包括心源性死亡、靶血管心肌梗死(TVMI)、缺血驱动的靶病变血运重建的复合终点;次要终点为TLF的各个组分及全因死亡。记录并比较3组患者的临床资料、介入资料及终点事件发生情况。结果3组患者高血压、高脂血症、既往心肌梗死、既往经皮冠状动脉介入治疗比例及肌酐清除率比较,差异均有统计学意义(P<0.05)。3组患者支架个数、支架总长度、靶血管位置比较,差异均有统计学意义(P<0.05)。3组患者TLF、TVMI发生率比较,差异均有统计学意义(P<0.05)。随着SYNTAX评分增加,置入BP-DES与DP-DES患者中TLF、TVMI发生风险均呈上升趋势;随着SYNTAX评分增加,置入BP-DES患者发生TVMI风险持续低于置入DP-DES患者,置入两种支架后发生TLF风险无显著差异。结论随着SYNTAX评分增加,置入BP-DES、DP-DES患者发生TLF、TVMI的风险均升高,而置入BP-DES患者发生TVMI的风险持续低于置入DP-DES患者。

Objective To investigate the effect of biodegradable polymer drug-eluting stent(BP-DES)or durable polymer drug-eluting stent(DP-DES)on long-term clinical prognosis in patients with coronary artery disease based on different SYNTAX score.Methods 2737 patients with BP-DES or DP-DES implanted in the I-LOVE-IT 2 study were selected as the study subjects.According to SYNTAX score,patients were divided into group A(SYNTAX score<7.0,n=774),group B(7.0≤SYNTAX score<13.5,n=1046),and group C(SYNTAX score≥13.5,n=917).The primary endpoint event of this study was 4-year target lesion failure(TLF),which included the combined endpoint of cardiac death,target vessels myocardial infarction(TVMI),and ischemia-driven target lesion revascularization.The secondary endpoints were all components of TLF and all-cause death.The clinical data,interventional data and endpoint events of the 3 groups were recorded and compared.Results There were significant differences in the proportion of hypertension,hyperlipidemia,previous myocardial infarction,previous percutaneous coronary intervention and creatinine clearance among 3 groups(P<0.05).There were statistically significant differences in the number of stents,total length of stents and location of target vessels among 3 groups(P<0.05).There were significant differences in the incidence of TLF and TVMI among 3 groups(P<0.05).With the increase of SYNTAX score,the risk of TLF and TVMI in BP-DES and DP-DES patients increased.With the increase of SYNTAX score,the risk of TVMI in patients with BP-DES implantation was continuously lower than that in patients with DP-DES implantation,and there was no significant difference in the risk of TLF after implantation of the two stents.Conclusion With the increase of SYNTAX score,the risk of TLF and TVMI in patients with BP-DES and DP-DES increases,while the risk of TVMI in patients with BP-DES is continuously lower than that in patients with DP-DES.