Gruberg L, Hong M K, Mintz G S, Mehran R, Waksman R, Dangas G, Kent K M, Pichard A D, Satler L F, Lansky A J, Kornowski R, Stone G W, Leon M B
Cardiovascular Research Foundation, New York, New York 10022, USA.
Am J Cardiol. 2000 Feb 1;85(3):333-7. doi: 10.1016/s0002-9149(99)00742-0.
Results from earlier trials performed before the implementation of optimal stent deployment techniques suggest that stenting for restenotic lesions may be associated with a higher risk of restenosis when compared with de novo lesions. The aim of this study was to compare the short- and long-term outcome of optimal stent deployment in restenotic versus de novo lesions. In all, 1,865 consecutive patients with 2,707 de novo lesions and 489 patients with 633 restenotic lesions underwent intravascular ultrasound-guided optimal stent deployment. In-hospital outcome was similar for both groups, except for a higher incidence of non-Q-wave myocardial infarction in the de novo group (14.6% vs 8.6%, p = 0.001). At 12-month follow-up, there was no statistical significant difference in the incidence of death or myocardial infarction, but event-free survival was better in the de novo lesion group of patients (74.5% vs 63.7%, p = 0.001). There was a higher incidence of target lesion revascularization in the restenosis group (25.1% vs 13.0%, p = 0.001). By multivariate analysis, restenotic lesions, vein graft lesions, and diabetes mellitus were strong determinants of repeat revascularization, whereas larger preprocedural reference vessel minimal lumen diameter and larger final minimal lumen diameter were associated with a reduced chance of restenosis and increased event-free survival. This study shows that optimal stent deployment for restenotic and de novo lesions has favorable short- and long-term outcome. However, the incidence of target lesion revascularization was significantly greater in restenotic lesions. Saphenous vein graft lesions and diabetes mellitus were confirmed as other independent risk factors for clinical restenosis.
在实施最佳支架置入技术之前进行的早期试验结果表明，与初发病变相比，对再狭窄病变进行支架置入可能与更高的再狭窄风险相关。本研究的目的是比较在再狭窄病变与初发病变中进行最佳支架置入的短期和长期结果。共有1865例连续患者的2707处初发病变以及489例患者的633处再狭窄病变接受了血管内超声引导下的最佳支架置入。两组的院内结局相似，但初发病变组非Q波心肌梗死的发生率更高（14.6%对8.6%，p=0.001）。在12个月随访时，死亡或心肌梗死的发生率无统计学显著差异，但初发病变组患者的无事件生存率更好（74.5%对63.7%，p=0.001）。再狭窄组的靶病变血运重建发生率更高（25.1%对13.0%，p=0.001）。通过多变量分析，再狭窄病变、静脉桥病变和糖尿病是再次血运重建的强决定因素，而术前参考血管最小管腔直径较大和最终最小管腔直径较大与再狭窄机会减少及无事件生存率增加相关。本研究表明，对再狭窄病变和初发病变进行最佳支架置入具有良好的短期和长期结果。然而，再狭窄病变中靶病变血运重建的发生率显著更高。大隐静脉桥病变和糖尿病被确认为临床再狭窄的其他独立危险因素。
