Background Though drug-eluting stent （DES） almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decr...Background Though drug-eluting stent （DES） almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decrease the use of DES, probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era. Methods From April 2004 to October 2006, 848 patients with multilesion disease underwent hybrid stent implantation. During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital. According to propensity score matching, we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study. We obtained the 24-month clinical outcome including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We used Cox＇s proportional-hazard models to assess relative risks of all the outcome measures after propensity match. Results At 24 months, patients in the hybrid stent implantation group showed a significantly higher risk of TLR （8.39% vs. 3.28%, HR2.38, 95% Cl. 1.50-3.70）, TVR （11.07% vs. 6.32%,/-/R 1.61, 95% Cl. 1.15-2.27） and MACE （13.75% vs. 8.75%, FIR 1.37, 95% Cl. 1.02-1.85）. No significant difference was apparent in terms of mortality （1.22% vs. 1.70%, HR 0.55, 95% Cl. 0.24-1.25）, MI （1.95% vs. 2.31%, HR0.73, 95% Cl. 0.37-1.42）, or thrombosis （definite＋probable） （0.73% vs. 1.58%, HR0.40, 95% Cl. 0.15-1.05）. Conclusions In patients with multilesion coronary artery disease, the exclusive DES implantation was associated with significantly lower risks of TLR, TVR and MACE, and the hybrid stent implantation did not result in any significant improvements regarding safety issues. Prospective studies are needed to confirm our results.展开更多
目的探讨冠状动脉支架术后患者的症状分布特征,并分析高症状负担人群的预测因素。方法于2023年3-5月采用便利抽样的方法,选取湖南省衡阳市某2所三级甲等综合医院接受冠状动脉支架术的366例冠心病患者为研究对象。使用患者报告结局测量...目的探讨冠状动脉支架术后患者的症状分布特征,并分析高症状负担人群的预测因素。方法于2023年3-5月采用便利抽样的方法,选取湖南省衡阳市某2所三级甲等综合医院接受冠状动脉支架术的366例冠心病患者为研究对象。使用患者报告结局测量信息系统(patient-repotred outcomes measurement information system,PROMIS)特征集进行调查,应用潜在类别分析(latent class analysis,LCA)、单因素分析、logistic回归分析确定术后患者症状的特征分类,并探索各类别的区分因素。结果LCA结果表明,冠状动脉支架术后患者的健康相关症状存在3个潜在类别,分别为高心理症状组(33%)、低症状组(48.1%)、高生理症状组(18.9%)。不同类别患者在身体功能、社会功能、疼痛强度上的差异有统计学意义(P<0.05)。年龄、文化程度、心功能水平、合并其他慢性病状况及支架植入个数是预测冠状动脉支架术后患者症状类别的重要因素(P<0.05)。结论冠状动脉支架术后患者存在3种类别的症状特征,照护时可依据区分3类别的预测因素对患者精准识别,有效管理。且3组患者的身体功能均有一定程度受限,以高生理症状组尤其明显;高心理症状组需重点关注其社会功能。展开更多
文摘Background Though drug-eluting stent （DES） almost solved a problem of restenosis, safety issues related to stent thrombosis are still the major concern of DES. We hypothesized that hybrid stent implantation may decrease the use of DES, probably improving the long-term safety but not affecting efficacy adversely when treating multilesion coronary artery disease in the DES era. Methods From April 2004 to October 2006, 848 patients with multilesion disease underwent hybrid stent implantation. During the same period 5647 patients with multilesion coronary heart disease were treated by exclusive DES implantation in Fu Wai Hospital. According to propensity score matching, we chose 823 pairs of patients with multileison coronary artery disease for inclusion into our study. We obtained the 24-month clinical outcome including death, myocardial infarction （MI）, thrombosis, target lesion revascularization （TLR）, target vessel revascularization （TVR）, and major adverse cardiac events （MACE, the composite of death, MI, and TVR）. We used Cox＇s proportional-hazard models to assess relative risks of all the outcome measures after propensity match. Results At 24 months, patients in the hybrid stent implantation group showed a significantly higher risk of TLR （8.39% vs. 3.28%, HR2.38, 95% Cl. 1.50-3.70）, TVR （11.07% vs. 6.32%,/-/R 1.61, 95% Cl. 1.15-2.27） and MACE （13.75% vs. 8.75%, FIR 1.37, 95% Cl. 1.02-1.85）. No significant difference was apparent in terms of mortality （1.22% vs. 1.70%, HR 0.55, 95% Cl. 0.24-1.25）, MI （1.95% vs. 2.31%, HR0.73, 95% Cl. 0.37-1.42）, or thrombosis （definite＋probable） （0.73% vs. 1.58%, HR0.40, 95% Cl. 0.15-1.05）. Conclusions In patients with multilesion coronary artery disease, the exclusive DES implantation was associated with significantly lower risks of TLR, TVR and MACE, and the hybrid stent implantation did not result in any significant improvements regarding safety issues. Prospective studies are needed to confirm our results.
文摘目的探讨冠状动脉支架术后患者的症状分布特征,并分析高症状负担人群的预测因素。方法于2023年3-5月采用便利抽样的方法,选取湖南省衡阳市某2所三级甲等综合医院接受冠状动脉支架术的366例冠心病患者为研究对象。使用患者报告结局测量信息系统(patient-repotred outcomes measurement information system,PROMIS)特征集进行调查,应用潜在类别分析(latent class analysis,LCA)、单因素分析、logistic回归分析确定术后患者症状的特征分类,并探索各类别的区分因素。结果LCA结果表明,冠状动脉支架术后患者的健康相关症状存在3个潜在类别,分别为高心理症状组(33%)、低症状组(48.1%)、高生理症状组(18.9%)。不同类别患者在身体功能、社会功能、疼痛强度上的差异有统计学意义(P<0.05)。年龄、文化程度、心功能水平、合并其他慢性病状况及支架植入个数是预测冠状动脉支架术后患者症状类别的重要因素(P<0.05)。结论冠状动脉支架术后患者存在3种类别的症状特征,照护时可依据区分3类别的预测因素对患者精准识别,有效管理。且3组患者的身体功能均有一定程度受限,以高生理症状组尤其明显;高心理症状组需重点关注其社会功能。
