药物洗脱支架对完全闭塞性病变介入治疗预后影响的评估  

Clinical and angiographic outcome in patients undergoing elective bare-metal stenting or drug-eluting stenting for total occlusion lesion

作　　者：乔树宾[1] 侯青[1] 徐波[1] 陈珏[1] 刘海波[1] 杨跃进[1] 吴永健[1] 袁晋青[1] 吴元[1] 戴军[1] 尤士杰[1] 马卫华[1] 张沛[1] 高展[1] 窦克非[1] 邱洪[1] 慕朝伟[1] 陈纪林[1] 高润霖[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院冠心病诊疗中心,北京100037

出　　处：《中华心血管病杂志》2006年第11期979-982,共4页Chinese Journal of Cardiology

基　　金：科技部社会公益基金(2002DIB40092)

摘　　要：目的比较对于完全性闭塞病变采用药物洗脱支架和金属裸支架的近期和远期预后。方法选择我院近期连续接受置入药物洗脱支架(DES)或金属裸支架(BMS)治疗,并且进行冠状动脉造影随访的155例存在完全闭塞病变的冠心病患者。患者在支架术后6个月左右接受冠状动脉造影随访。结果共155例患者(138名男性,17名女性)159处靶病变置入232枚支架完成造影随访,其中慢性完全性闭塞65例,占41.9%。其中C型病变占总数的85.4%。在患者基本条件方面,DES组2型糖尿病比例要多于BMS组(33.8%比18.5%,P=0.030)。在病变基本条件方面,DES组和BMS组C型病变分别占89.6%和72.0%(P=0.005),DES组病变更为复杂。DES组慢性完全闭塞病变比例明显高于BMS组(60.3%比24.4%,P<0.001)。DES组和BMS组的支架长度和病变长度没有差别。DES组参考血管直径小于BMS组[(2.72±0.36)mm比(2.96±0.52)mm,P=0.001]。6个月随访结果显示支架再狭窄DES组明显低于BMS组(15.6%比41.5%,P<0.001)。DES组支架再狭窄更多为局限性(58.3%比17.6%,P<0.001)。DES组的靶病变血管重建率明显低于BMS组(5.8%比19.9%,P=0.001)。病变内晚期腔径丢失DES明显小于BMS[(0.36±0.63)mm比(1.04±0.70)mm,P<0.001]。晚期支架内血栓DES有2例,BMS为0。DES组有1例死亡。术后主要心脏不良事件发生率两组分别是1.4%和11.1%,DES组显著低于BMS组(P=0.032)。结论我们的研究发现对于完全闭塞性病变的治疗,DES有着良好的治疗效果,比BMS有着明显减低的再狭窄率、靶病变血管重建率,并且在随访期间患者有着更少的心血管事件。Objective To compare the clinical and angiographic outcome in patients with total occlusion lesion treated with drug-eluting stent （DES） or bare-metal stent （BMS）. Methods A total of 155 （138 males） consecutive patients with total occlusion lesion underwent successful revascularization with DES （n = 74 ） or BMS （n = 81 ） in our hospital were included in this study. All patients received aspirin 300 mg and clopidogrel 75 mg once daily for at least 3 months after the procedure. Clinical and angiographic follow-up were completed in all patients at 6 months post stenting. Results Demographic data between the two groups were similar except there was more diabetic patients in DES group （33.8% vs. 18.5% , P 〈0. 05）. A total of 232 stents for 159 target lesions （77 treated with DES, 82 treated with BMS） were implanted. There were 85.4% C ACC/AHA type lesions and 17.0% lesions were treated with overlapping stents. Six months post stenting, the incidence of restenosis （ 15.6% vs. 41.5% , P 〈0. 001 ）, the cumulative rate of major adverse cardiac events （MACE） （ 1.4% vs. 11.1% , P = 0. 032） and TLR （5.8% vs. 19. 9% ,P =0. 001 ） were significantly lower in DES group than that of BMS group. The incidence of local restenosis in DES group is higher in DES group than that in BMS group（58.3%, 17.6%, P〈0.001）. Two DES treated patients developed late in-stent thrombosis. Conclusion For patients with total occlusion lesion, the clinical and angiographic outcome 6 months post DES stenting is clearly superior to that of BMS stenting.

关 键 词：冠状动脉疾病 支架 移植物闭塞 血管 完全闭塞性病变 

分 类 号：R543[医药卫生—心血管疾病]