第二代药物洗脱支架治疗局灶型和非局灶型支架内再狭窄疗效比较

Comparison in curative effects of second-generation drug-eluting stent in treatment of focal-type and nonfocal-type in-stent restenosis

目的比较第二代药物洗脱支架治疗局灶型和非局灶型支架内再狭窄病变的临床结局。方法入选2011年1月~2013年3月在首都医科大学附属北京安贞医院心内科因药物洗脱支架支架内再狭窄(DES-ISR)接受第二代药物洗脱支架(DES)治疗的患者254例,男性201例,女性53例。所有患者根据支架内再狭窄(ISR)病变造影类型分为局灶型组(87例)和非局灶组(167例)。所有患者随访2年,比较两组主要不良心血管事件(MACEs,包括心源性死亡、心肌梗死和靶病变血运重建等)发生情况,分析术后靶病变血运重建(TLR)的危险因素。结果非局灶型患者B2/C型病变比例明显高于局灶型(69.5%vs.41.4%),病变长度和支架长度均高于局灶型患者,为[(25.46±3.38)mm vs.(8.13±2.21)mm]、[(28.59±11.25)mm vs.(19.47±7.09)mm],差异有统计学意义(P均<0.01)。非局灶组MACEs发生率明显高于局灶组(38.3%vs.24.1%),TLR明显高于局灶组(32.3%vs.18.4%),差异均具有统计学意义(P均<0.05)。COX回归分析发现,非局灶ISR是TLR的独立危险因素(OR=2.134,95%CI:1.173~3.884)。Kapan-Meier生存曲线显示,局灶型患者接受第二代DES治疗术后2年内TLR生存率高于非局灶型患者(P=0.024)。结论第二代DES治疗DES-ISR时,局灶型ISR患者预后优于非局灶型ISR患者。

Objective To compared the clinical outcomes of focal-type in-stent restenosis(ISR) and nonfocal-type ISR treated with second-generation drug-eluting stent(DES). Methods The patients(n=254, male 201 and female 53) undergone second-generation DES due to DES-ISR were chosen from Jan. 2011 to Mar. 2013. All patients were divided into focal-type ISR group(n=87) and non-focal-type ISR group(n=167) according to the outcomes of angiography. The patients were followed up for 2 y, the incidence of major adverse cardiovascular events [MACE, including cardiac death, myocardial infarction and target lesion revascularization(TLR)] were compared in 2 groups, and risk factors of TLR were analyzed after treatment. Results The percentage of patients with B2/C lesion was significantly higher(69.5% vs. 41.4%), and lesion duration [(25.46±3.38) mm vs.(8.13±2.21) mm] and stent length [(28.59±11.25) mm vs.(19.47±7.09) mm] were higher in non-focal-type ISR group than those in focal-type ISR group(all P<0.01). The incidence of MACE(38.3% vs. 24.1%) was significantly higher and TLR(32.3% vs. 18.4%) was significantly higher in non-focal-type ISR group than those in focal-type ISR group(all P<0.01). COX regression analysis showed that non-focal-type ISR was an independent risk factor of TLR(OR=2.134, 95%CI: 1.173-3.884). Kapan-Meier survival curve showed that the survival rate of TLR was higher in focal-type ISR group than that in non-focal-type ISR group within 2 y after undergone second-generation DES(P=0.024). Conclusion When applying second-generation DES for treating DES-ISR, the prognosis is better in patients with focal-type ISR than that in patients with non-focal-type ISR.