Migliorini Angela, Moschi Guia, Vergara Ruben, Parodi Guido, Carrabba Nazario, Antoniucci David
Division of Cardiology, Careggi Hospital, Florence, Italy.
Catheter Cardiovasc Interv. 2006 Mar;67(3):344-8. doi: 10.1002/ccd.20623.
This study sought to determine the clinical and angiographic outcomes after drug-eluting stent (DES)-supported percutaneous coronary intervention (PCI) for chronic total coronary occlusion (CTO).
There are few data about the efficacy of DES-supported PCI for CTO.
All consecutive patients who had a sirolimus-eluting stent or a paclitaxel-eluting stent implanted for CTO from December 2003 to December 2004 were analyzed. Clinical and angiographic outcomes of patients treated with DES were compared with a case-matched control group of patients treated with bare metal stents (BMS) in the 12 months before the routine use of DES.
Successful DES-supported PCI was performed in 92 patients and 104 CTO. The case-matched control group consisted of 26 patients and 27 CTO successfully treated with BMS. There were no differences between groups in baseline clinical and angiographic characteristics. Stent length in the DES group was higher as compared with that of BMS group (51+/-28 mm vs. 40+/-19 mm, P=0.073). The 6-month major adverse cardiac event (MACE) rate was lower in the DES group as compared with that of BMS group (9.8% vs. 23%, P=0.072). The angiographic follow-rate was 80% in the DES group and 81% in the BMS group. The 6-month restenosis rate was 19% in the DES group and 45% in the BMS group (P<0.001). By multivariate analysis, it was found that in the DES group, the only predictors of restenosis were stented segment length (OR 1.031, 95% CI 1.01-1.06, P=0.009) and a target vessel reference diameter<2.5 mm (OR 6.48, 95% CI 1.51-27.83, P=0.012), while the only predictor of MACE was stent length (OR 1.04, 95% CI 1.01-1.08, P=0.006).
DES implantation for CTO decreases the risk of mid-term restenosis and MACE. Small vessels and diffuse disease requiring the implantation of multiple stents and very long stents for full coverage of the target lesion are still associated with a relatively high risk of restenosis.
本研究旨在确定药物洗脱支架（DES）支持下的经皮冠状动脉介入治疗（PCI）用于慢性完全冠状动脉闭塞（CTO）后的临床和血管造影结果。
关于DES支持下的PCI治疗CTO的疗效数据较少。
分析了2003年12月至2004年12月期间所有因CTO植入西罗莫司洗脱支架或紫杉醇洗脱支架的连续患者。将DES治疗患者的临床和血管造影结果与在常规使用DES前12个月内接受裸金属支架（BMS）治疗的病例匹配对照组患者进行比较。
92例患者和104处CTO成功接受了DES支持下的PCI。病例匹配对照组由26例患者和27处CTO组成，这些患者成功接受了BMS治疗。两组在基线临床和血管造影特征方面无差异。DES组的支架长度高于BMS组（51±28mm对40±19mm，P = 0.073）。DES组6个月主要不良心脏事件（MACE）发生率低于BMS组（9.8%对23%，P =
