应用药物涂层支架与金属裸支架在处理冠脉大血管病变中的远期临床效果对比  

Comparison of Long-term Clinical Outcome between Drug-Eluting and Bare Metal Stents in Treating Large Coronary Vessel Lesions

作　　者：丰雷[1] 王昊[1] 赵志勇[1] 高国峰[1] 徐晗[1] 刘帅[1] 尹栋[1] 窦克非[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037

出　　处：《中国分子心脏病学杂志》2016年第6期1905-1910,共6页Molecular Cardiology of China

摘　　要：目的评估药物涂层支架(drug-eluting stents,DES)与金属裸支架(bare-metal stents,BMS)在处理冠状动脉大血管病变时的安全性和有效性。方法连续入选2407位行经皮冠脉介入治疗(percutaneous coronary intervention,PCI)的患者,靶血管直径均不小于3.5mm。通过随访收集9年的临床数据包括死亡、心肌梗死、支架内血栓、靶病变血运重建(target lesion revascularization,TLR)、TVR(target vessel revascularization,TVR)以及主要不良事件(major adverse cardiac events,MACE,包括死亡、心肌梗死以及TVR的复合终点)。在进行倾向性匹配后,采用COX比例风险模型来检验所有事件的相对风险。结果与DES组相比,BMS组的TLR和TVR风险有所增加:TLR(HR 2.55,95%CI 1.520–4.277,P=0.0004),TVR(HR 1.889,95%CI 1.185–3.011,P=0.0075)。而在死亡、心肌梗死以及MACE方面两组之间未表现出统计学差异。结论经过9年的临床观察,在冠状动脉大血管病变的患者中植入BMS并不能改善预后,相反DES可以有效降低TVR及TLR的风险。Objectives This study sought to evaluate the safety and effectiveness of DES compared to BMS for patients with large coronary vessels. Methods 2407 consecutive patients undergoing PCI with reference vessel diameter greater than or equal to 3.5 mm were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction（MI）, thrombosis, TLR, TVR, and MACE（the composite of death, MI, and TVR）. We used Cox＇s proportional-hazards models to assess relative risks of all the outcome measures after propensity match. Results The patients treated with BMS were associated with higher risk of TLR（HR 2.55, 95%CI 1.520–4.277, p=0.0004） and TVR（HR 1.889, 95%CI 1.185–3.011, p=0.0075）, but the rates of death/MI and MACE were not statistically different. Conclusions In patients requiring stenting of large coronary arteries, use of DES was associated with significant reductions in the risks of TLR and TVR at a 9-year long-term follow-up.

关 键 词：冠状动脉大血管 药物涂层支架 金属裸支架 靶血管血运重建性 

分 类 号：R543.3[医药卫生—心血管疾病]