冠状动脉长病变患者置入雷帕霉素洗脱支架和紫杉醇洗脱支架2年临床观察  

Two-year clinical outcome after successful implantation of sirolimus-eluting and paclitaxel-eluting stents in patients with long coronary lesions: results from a real-world single center registry

作　　者：尹栋[1] 窦克非[1] 杨跃进[1] 徐波[1] 陈珏[1] 刘海波[1] 姚民[1] 秦学文[1] 吴永健[1] 李建军[1] 乔树宾[1] 尤士杰[1] 袁晋青[1] 戴军[1] 陈纪林[1] 高润霖[1] 陈在嘉[1] 

机构地区：[1]北京市中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院冠心病中心,100037

出　　处：《中国介入心脏病学杂志》2013年第1期12-16,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的评价冠状动脉长病变患者成功置入Firebird雷帕霉素洗脱支架和Taxus紫杉醇洗脱支架2年后的有效性和安全性。方法本研究入选了2004年4月至2006年10月期间,在阜外心血管病医院行择期经皮冠状动脉介入治疗(PCI)的冠状动脉长病变患者826例。入选患者分为Firebird组(666例)和Taxus组(160例)。随访资料包括术后30天、1年和2年的死亡、心肌梗死、血栓、靶病变血运重建和靶血管血运重建。本研究比较了两组间各种临床事件的累积发生率差异。同时通过倾向性评分调整后的Cox比例风险模型比较两组间的2年临床随访结果。结果两组病变长度[(45.62±15.25)mm比(44.09±13.67)mm]及置入支架长度[(51.22±16.64)mm比(49.63±15.86)mm]相似(P>0.05)。术后2年,Firebird组靶病变血运重建率(3.46%比10.00%,P=0.0005)、靶血管血运重建率(5.42%比11.25%,P=0.008)及MACE发生率(10.99%比20.00%,P=0.002)方面显著低于Taxus组。两组患者术后2年支架肯定或可能血栓形成的发生率差异均无统计学意义。经倾向性评分调整后,与Taxus组相比,应用Firebird支架治疗的患者在术后2年时MACE风险降低(危险比0.622,95%CI:0.401～0.965,P=0.034),而其他临床事件的风险比差异无统计学意义。结论对于冠状动脉长病变患者而言,使用Firebird雷帕霉素洗脱支架MACE发生率较低,而靶病变血运重建率和靶血管血运重建率方面不劣于Taxus紫杉醇洗脱支架,且风险有下降趋势。Objective There are few studies comparing long-term outcomes of percutaneous coronary intervention （PCI） with different drug-eluting stents for long coronary lesions. The present study seeks to compare the 2-years clinical outcome after SES and PES implantation in a real-world setting of patients with long coronary lesions. Methods From April 2004 to October 2006, 826 consecutive patients with long coronary lesions, who underwent elective stenting successfully at Fu Wai Hospital in Beijing, China, were prospectively enrolled in this study. All enrolled patients were divided into Firebird SES group （n =666） and Taxus PES group （n = 160）. We obtained follow-up data, including death, myocardial infarction （MI）, thrombus, target lesion revascularization （TLR） and target vessel revascularization （TVR） defined by Academic Research Consortium （ARC） definition, at 30 days and 12 and 24 months after PCI. We compared all the unadjusted cumulative frequencies of the various adverse events in the two groups. Cox proportional-hazards models adjusted with the propensity score were used to assess relative risks of all the outcome measures at 24 months. Results Mean lesion length （45.62 ± 15.25 mm in SES and 44. 09 ±13.67 mm in PES, P =0. 181 ） and mean stent length （51.22 ± 16. 64 mm in SES and 49. 63 ±15.86 mm in PES, P = 0. 204） did not differ significantly between groups. Patients treated with SES showed significant lowerrisk of TLR （3.46% vs. 10.00%, P=0.0005）, TVR （5.42% vs. 11.25%, P=0.008） and MACE （10. 99% vs. 20. 00%, P =0. 002） at 24-month, but no difference in terms of all-cause mortality, MI and definite stent thrombosis. All the specifications of thrombosis rates were comparable between the two groups. After propensity score adjustment, patients treated with Firebird SES showed significant lower risk of MACE （ HR, O. 622 （95 % C!： 0. 401-0. 965 ）, P = 0. 034 ） at 24-month, but no difference was apparent in terms of all-cause mortality, MI, TLR and TVR.

关 键 词：冠心病 药物洗脱支架 治疗结果 

分 类 号：R543.3[医药卫生—心血管疾病]