Jang Jae-Sik, Hong Myeong-Ki, Lee Cheol Whan, Park Duk-Woo, Lee Bong-Ki, Kim Young-Hak, Han Ki-Hoon, Kim Jae-Joong, Park Seong-Wook, Park Seung-Jung
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
J Invasive Cardiol. 2006 May;18(5):205-8.
This study evaluated the clinical and angiographic effectiveness of sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantation for chronic total occlusion (CTO) lesions.
It has not been known which drug-eluting stent, SES vs. PES, is superior for the treatment of CTO lesions.
This study comprises 107 CTO lesions which were successfully treated with SES implantation and 29 CTO lesions with PES implantation. Six-month angiographic restenosis rates and major adverse cardiac events (MACE) including death, nonfatal myocardial infarction and target lesion revascularization were compared between the two groups.
Baseline clinical characteristics were similar between the two groups. The procedural success rate was 98.1% in the SES group and 100% in the PES group. There was 1 sudden death due to in-hospital acute thrombosis in the PES group. There were no significant differences in baseline angiographic measures between both groups, except larger postprocedural minimal luminal diameter and acute gain in the PES group. At 6-month angiographic follow up, the restenosis rate was significantly higher in the PES group (28.6% vs. 9.4%; p = 0.020). Similarly, the late loss was significantly higher in the PES group (0.8 +/- 0.8 mm vs. 0.4 +/- 0.8 mm; p = 0.025). At one-year follow up, the MACE-free survival rate was significantly higher in the SES group (95.8% vs. 85.8%; p = 0.049).
The implantation of SES in the treatment of CTO lesions showed more favorable results regarding restenosis and clinical outcomes compared with PES implantation.
本研究评估了西罗莫司洗脱支架（SES）和紫杉醇洗脱支架（PES）植入治疗慢性完全闭塞（CTO）病变的临床及血管造影效果。
目前尚不清楚哪种药物洗脱支架，即SES与PES，在治疗CTO病变方面更具优势。
本研究纳入了107例成功植入SES的CTO病变和29例植入PES的CTO病变。比较了两组患者6个月时的血管造影再狭窄率以及包括死亡、非致命性心肌梗死和靶病变血运重建在内的主要不良心脏事件（MACE）。
两组患者的基线临床特征相似。SES组的手术成功率为98.1%，PES组为100%。PES组有1例因院内急性血栓形成导致的猝死。两组之间基线血管造影测量值无显著差异，但PES组术后最小管腔直径和急性增加较大。在6个月的血管造影随访中，PES组的再狭窄率显著更高（28.6%对9.4%；p = 0.020）。同样，PES组的晚期管腔丢失显著更高（0.8±0.8mm对0.4±0.8mm；p = 0.025）。在1年随访时，SES组的无MACE生存率显著更高（95.8%对85.8%；p = 0.049）。
与植入PES相比，植入SES治疗CTO病变在再狭窄和临床结局方面显示出更有利的结果。
