不同药物洗脱支架在冠状动脉弥漫性长病变中的2年随访结果比较  

Two-year clinical and angiographic outcomes of overlapping sirolimus-versus paclitaxel-eluting stents in the treatment of diffuse long coronary lesions

作　　者：郑心田[1] 陈康寅[1] RHA Seung-Woon 李永健[3] 李广平[1] 

机构地区：[1]天津医科大学第二医院心脏科,300211 [2]韩国高丽大学附属九老医院心脏中心 [3]天津市南开医院心内科

出　　处：《中国介入心脏病学杂志》2013年第6期354-357,共4页Chinese Journal of Interventional Cardiology

摘　　要：目的评价在冠状动脉弥漫性长病变中使用重叠西罗莫司（雷帕霉素）洗脱支架（SES）与重叠紫杉醇洗脱支架（PES）的疗效及安全性。方法研究入选冠状动脉弥漫性长病变患者197例,分别接受重叠SES（CypherTM,75例,110处病变）或PES（TaxusTM,122例,177处病变）。比较两组随访6个月时造影及随访2年时的临床结果。结果随访6个月时造影结果表明,SES组最小管腔直径显著高于PES组（P=0.013）;晚期管腔丢失、再狭窄百分比和二元再狭窄率显著低于PES组（P均〈0.05）。2年临床随访结果显示,SES组总死亡率、靶病变血运重建、靶血管血运重建及主要不良心脏事件的发生率显著低于PES组（P均〈0.05）。多因素回归分析显示,相较于PES,SES是随访2年时总死亡（OR=0.20,95%CI：0.05~0.83,P=0.027）、靶病变重建（OR=0.26,95%CI：0.10~0.73,P=0.010）和主要不良心脏事件（OR=0.38,95%CI：0.18~0.82,P=0.014）的独立保护性预测因素。结论在冠状动脉弥漫性长病变治疗中,相较于重叠使用PES,重叠SES显著改善了6个月时的造影随访结果,并且该结果能转化成为更佳的2年临床随访结果。Objective To compare the 6-month angiographic and 2-year clinical outcomes of the same overlapping sirolimus-eluting stent（ SES） versus paclitaxel-eluting stent（ PES） in patients with coronary diffuse long lesions. Methods A total of 197 patients who underwent percutaneous coronary intervention（ PCI） with overlapping SES（ CYPHERTM,n = 75pts,110 lesions） or PES（ TAXUSTM,n = 122 pts,177 lesions） were enrolled. Angiographic at 6 months and clinical outcomes at 2 years were evaluated. Results Six-month angiographic results showed that SES group had less late loss,restenosis percentage and lower rate of binary restenosis as compared with PES group. Two-year clinical outcomes showed that despite the similar rates of cardiac death,myocardial infarction（ MI） between the two groups. SES group had lower incidences of target lesion revascularization（ TLR）,target vessel revascularization（ TVR）,and major adverse cardiac events（ MACE） as compared with PES group. Furthermore, multivariable Logistic analyses showed that the use of SES（ vs. PES） was an independent protective predictor of 2-year total death（ OR 0. 20,95% CI 0. 05- 0. 83,P = 0. 027）,TLR（ OR 0. 26,95% CI 0. 10- 0. 73,P = 0. 010） and MACE（ OR 0. 38,95% CI 0. 18- 0. 82,P = 0. 014）. Conclusions The treatment for diffuse long lesions with overlapping SES had more favorable angiographic outcomes at 6 months which could be translated into superior clinical outcomes at 2 years as compared with overlapping PES, suggesting SES would be preferred for this subset of lesions.

关 键 词：弥漫性长病变 紫杉醇洗脱支架 西罗莫司(雷帕霉素)洗脱支架 

分 类 号：R541.4[医药卫生—心血管疾病]