Holmes David R, Kereiakes Dean J, Laskey Warren K, Colombo Antonio, Ellis Stephen G, Henry Timothy D, Popma Jeffrey J, Serruys Patrick W J C, Kimura Takeshi, Williams David O, Windecker Stephan, Krucoff Mitchell W
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55955, USA.
J Am Coll Cardiol. 2007 Jul 10;50(2):109-18. doi: 10.1016/j.jacc.2007.04.032. Epub 2007 May 22.
Stent thrombosis (ST) after percutaneous coronary intervention has been the focus of intense interest because of its attendant morbidity and mortality. There is controversy about several facets of the problem. These include the frequency of ST with drug-eluting stents (DES) versus bare-metal stents (BMS), the timing of the event, clinical consequences, risk factors, adjunctive therapy, and new preventive approaches. Information has accrued rapidly from several sources, including randomized controlled clinical trials of DES versus BMS in carefully selected subsets of patients and registry experiences in larger patient groups, which provide a more universal real-world picture. The results from these different data sets are not completely concordant. However, several general conclusions can be made: 1) ST is an infrequent but very severe complication of both BMS and DES; 2) at the present time, during 4 years of follow-up from randomized controlled trials that compared DES and BMS, there is no apparent difference in overall ST frequency, although the time course for occurrence appears to differ, with a relative numeric excess of ST late after DES implant; 3) despite this relative imbalance, no differences in the end points of death or death and infarction between DES and BMS are observed; 4) longer-term follow-up of these patients as well as larger angiographic and clinical subsets of patients who receive this technology outside of randomized trials are required to fully study this issue; and 5) advances in stent platforms for drug elution as well as adjunctive pharmacologic therapy are being evaluated to enhance long-term safety.
经皮冠状动脉介入治疗后的支架血栓形成（ST）因其伴随的发病率和死亡率一直是人们密切关注的焦点。关于这个问题的几个方面存在争议。这些方面包括药物洗脱支架（DES）与裸金属支架（BMS）相比ST的发生率、事件发生的时间、临床后果、危险因素、辅助治疗以及新的预防方法。来自多个来源的信息迅速积累，包括在精心挑选的患者亚组中进行的DES与BMS的随机对照临床试验以及更大患者群体的注册研究经验，这些提供了更具普遍性的真实世界情况。这些不同数据集的结果并不完全一致。然而，可以得出几个一般性结论：1）ST是BMS和DES罕见但非常严重的并发症；2）目前，在比较DES和BMS的随机对照试验4年随访期间，总体ST发生率没有明显差异，尽管发生时间过程似乎不同，DES植入后晚期ST的相对数量有所增加；3）尽管存在这种相对不平衡，但DES和BMS在死亡或死亡及梗死终点方面没有观察到差异；4）需要对这些患者进行更长时间的随访以及对在随机试验之外接受该技术的更大血管造影和临床患者亚组进行研究，以充分研究这个问题；5）正在评估药物洗脱支架平台以及辅助药物治疗方面的进展，以提高长期安全性。
