Orlic Dejan, Bonizzoni Erminio, Stankovic Goran, Airoldi Flavio, Chieffo Alaide, Corvaja Nicola, Sangiorgi Giuseppe, Ferraro Massimo, Briguori Carlo, Montorfano Matteo, Carlino Mauro, Colombo Antonio
EMO, Centro Cuore Columbus Hospital, Milan, Italy.
J Am Coll Cardiol. 2004 Apr 7;43(7):1154-60. doi: 10.1016/j.jacc.2003.10.052.
This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (SES) in unselected lesions.
Safety and effectiveness of multivessel SES implantation is currently unknown.
Major adverse cardiac events (MACE) (death, myocardial infarction [MI], and repeat revascularization) were analyzed at 30 days and at 6 months after multivessel SES implantation.
In 155 consecutive patients, 573 SES were implanted in 3.3 +/- 1.3 lesions per patient. At 30 days, the cumulative MACE rate was 10.3%: 7.1% patients developed a non-Q-wave MI, 1.9% developed a Q-wave MI, 0.6% died for non-cardiac reasons, and 0.6% had a repeat revascularization. Clinical follow-up was obtained in all 112 eligible patients treated for 359 lesions at a mean time of 6.5 +/- 2.2 months. The cumulative MACE rate was 22.3%: 3 (2.7%) deaths (1 for cardiac reasons), 4 (3.6%) MIs, target lesion revascularization (TLR) in 16 (14.3%) patients with 24 (6.7%) lesions. Target vessel revascularization was required in 18 (16.1%) patients due to TLR of lesions treated with SES or to disease progression (1.8% of patients). Cox regression analysis revealed total stent length per patient as the most powerful independent predictor of MACE. Overall stent thrombosis occurred in three (1.9%) patients.
Multivessel SES implantation can be safely performed on patients with complex coronary artery disease. The need for revascularization increases because of the cumulative effect of TLR on patients with multiple lesions.
本研究评估了在未经选择的病变中使用西罗莫司洗脱支架（SES）进行多支血管支架置入术后的临床结局。
目前尚不清楚多支血管SES植入的安全性和有效性。
在多支血管SES植入术后30天和6个月时分析主要不良心脏事件（MACE）（死亡、心肌梗死[MI]和再次血运重建）。
在155例连续患者中，共植入573枚SES，每位患者植入3.3±1.3处病变。在30天时，累积MACE发生率为10.3%：7.1%的患者发生非Q波心肌梗死，1.9%的患者发生Q波心肌梗死，0.6%的患者因非心脏原因死亡，0.6%的患者进行了再次血运重建。在平均时间为6.5±2.2个月时，对所有112例接受359处病变治疗的符合条件患者进行了临床随访。累积MACE发生率为22.3%：3例（2.7%）死亡（1例因心脏原因），4例（3.6%）心肌梗死，16例（14.3%）患者的24处（6.7%）病变进行了靶病变血运重建（TLR）。由于SES治疗病变的TLR或疾病进展，18例（16.1%）患者需要进行靶血管血运重建（占患者的1.8%）。Cox回归分析显示每位患者的总支架长度是MACE最有力的独立预测因素。3例（1.9%）患者发生了总体支架血栓形成。
多支血管SES植入术可安全地应用于复杂冠状动脉疾病患者。由于TLR对多病变患者的累积效应，血运重建的需求增加。
