Lee Cheol Whan, Suh Jon, Lee Se-Whan, Park Duk-Woo, Lee Seung-Hwan, Kim Young-Hak, Hong Myeong-Ki, Kim Jae-Joong, Park Seong-Wook, Park Seung-Jung
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Catheter Cardiovasc Interv. 2007 May 1;69(6):821-5. doi: 10.1002/ccd.21019.
Predictors of cardiac events and restenosis after sirolimus-eluting stent (SES) implantation in small coronary arteries were evaluated.
Although SES implantation has markedly reduced the risk of restenosis, small vessel disease remains a major cause of SES failure.
We prospectively investigated the factors predictive of cardiac events and restenosis in 1,092 consecutive patients who received SES implantation for 1,269 lesions in small coronary arteries (< or = 2.8 mm). Follow-up angiography at 6 months was performed in 751 patients with 889 lesions (follow-up rate 70.3%).
Restenosis (diameter stenosis > or = 50%) was angiographically documented in 65 patients with 77 lesions (8.7%): 55 focal (71.4%), 8 diffuse (10.4%), 2 diffuse proliferative (2.6%), and 12 total (15.6%). Lesion length, stent length, reference artery size, and in-stent restenotic lesions were univariate predictors of restenosis. By multivariate analysis, lesion length (OR 1.04; 95% CI 1.02-1.05; P < 0.001) and in-stent restenotic lesions (OR 3.38; 95% CI 1.80-6.35; P < 0.001) were significant independent predictors of restenosis. During follow-up (23.2 +/- 7.9 months), there were 17 deaths (5 cardiac and 12 noncardiac), 5 nonfatal Q-wave myocardial infarctions, and 42 target lesion revascularizations. The cumulative probability of survival without major adverse cardiac events (MACE) was (96.6 +/- 0.6)% at 1 year and (95.1 +/- 0.7)% at 2 years. In multivariate analysis, lesion length (HR 1.04; 95% CI 1.01-1.07; P = 0.004) and in-stent restenotic lesions (HR 3.29; 95% CI 1.58-6.86; P = 0.001) were independently related to MACE.
SES implantation in small coronary arteries is safe and effective, with lesion length having a major impact on restenosis and MACE.
评估西罗莫司洗脱支架（SES）植入小冠状动脉后心脏事件和再狭窄的预测因素。
尽管SES植入显著降低了再狭窄风险，但小血管病变仍是SES失败的主要原因。
我们前瞻性研究了1092例连续接受SES植入治疗1269处小冠状动脉（直径≤2.8mm）病变患者的心脏事件和再狭窄预测因素。751例患者的889处病变进行了6个月的随访血管造影（随访率70.3%）。
65例患者的77处病变（8.7%）血管造影显示有再狭窄（直径狭窄≥50%）：55处为局灶性（71.4%），8处为弥漫性（10.4%），2处为弥漫增殖性（2.6%），12处为完全闭塞性（15.6%）。病变长度、支架长度、参考动脉大小和支架内再狭窄病变是再狭窄的单因素预测因素。多因素分析显示，病变长度（OR 1.04；95%CI 1.02-1.05；P<0.001）和支架内再狭窄病变（OR 3.38；95%CI 1.80-6.35；P<0.001）是再狭窄的显著独立预测因素。随访期间（23.2±7.9个月），有17例死亡（5例心脏性和12例非心脏性），5例非致死性Q波心肌梗死，42例靶病变血运重建。无主要不良心脏事件（MACE）的累积生存率在1年时为（96.6±0.6）%，2年时为（95.1±0.7）%。多因素分析显示，病变长度（HR 1.04；95%CI 1.01-1.07；P=0.004）和支架内再狭窄病变（HR 3.29；95%CI 1.58-6.86；P=0.001）与MACE独立相关。
SES植入小冠状动脉安全有效，病变长度对再狭窄和MACE有重大影响。
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