Quizhpe Arturo R, Feres Fausto, de Ribamar Costa José, Abizaid Alexandre, Maldonado Galo, Costa Ricardo, Abizaid Andrea, Cano Manuel, Moreira Adriana C, Staico Rodolfo, Mattos Luiz Alberto, Tanajura Luiz Fernando, Chaves Aurea, Centemero Marinella, Sousa Amanda M R, Sousa J Eduardo M R
Institute Dante Pazzanese of Cardiology, São Paulo, SP, Brazil.
Am Heart J. 2007 Aug;154(2):373-8. doi: 10.1016/j.ahj.2007.04.027.
Lately drug-eluting stents (DES) have dramatically reduced restenosis rates and need for repeat revascularization in a wide subset of lesion and patients. However, their benefit for the treatment of large vessels (> 3.0 mm) has yet to be established.
We investigated whether DES are superior to bare metal stents (BMS) in terms of clinical outcomes for the treatment of large coronary vessels.
This study assessed the long-term outcomes (cardiac death, acute myocardial infarction, and need for repeat intervention in the treated vessel) of patients treated with either a DES (Cypher and Taxus) or a BMS of > or = 3.5 mm in diameter. A total of 250 consecutive patients who underwent DES implantation were clinically followed for 1 year and compared to 250 patients who were treated with BMS. Interventions in the setting of acute ST elevation myocardial infarction and treatment of bypass grafts were excluded.
Cypher was the DES deployed in 70.8% of cases. Most of the enrolled patients were men (78%) with single vessel disease (65.6%). The left anterior descending artery was the culprit vessel in 34.2% of cases. Bare metal stent and DES cohorts had equivalent interpolated reference vessel diameter (3.19 +/- 0.3 mm for BMS vs 3.18 +/- 0.2 for DES; P = .1). Lesion was significantly longer in the group treated with DES (13.4 +/- 5.1 mm for BMS group vs 14.3 +/- 3.5 for DES; P = .0018). After 1 year of clinical follow-up, 95.2% of patients treated with DES and 91.2% of the patients who received BMS were free of major events (P = .2). A trend toward higher target-lesion revascularization was noticed in the group treated with BMS (4.8% vs 1.6%; P = .07).
Percutaneous treatment of large coronary vessels carries a low risk of clinical events irrespective of the type of stent used.
近年来，药物洗脱支架（DES）已显著降低了多种病变类型和患者群体的再狭窄率以及再次血管重建的需求。然而，其在治疗大血管（直径> 3.0 mm）方面的益处尚未得到证实。
我们研究了在治疗大冠状动脉血管方面，DES在临床结局上是否优于裸金属支架（BMS）。
本研究评估了接受DES（西罗莫司洗脱支架和紫杉醇洗脱支架）或直径≥3.5 mm的BMS治疗的患者的长期结局（心源性死亡、急性心肌梗死以及治疗血管再次干预的需求）。总共250例连续接受DES植入的患者进行了为期1年的临床随访，并与250例接受BMS治疗的患者进行比较。急性ST段抬高型心肌梗死情况下的干预以及旁路移植术的治疗被排除。
西罗莫司洗脱支架在70.8%的病例中使用。大多数入组患者为男性（78%），患有单支血管病变（65.6%）。34.2%的病例中，左前降支为罪犯血管。裸金属支架组和DES组的平均参考血管直径相当（BMS组为3.19±0.3 mm，DES组为3.18±0.2 mm；P = 0.1）。DES治疗组的病变明显更长（BMS组为13.4±5.1 mm，DES组为14.3±3.5 mm；P = 0.0018）。经过1年的临床随访，95.2%接受DES治疗的患者和91.2%接受BMS治疗的患者无重大事件发生（P = 0.2）。BMS治疗组有更高的靶病变血管重建趋势（4.8%对1.6%；P = 0.07）。
无论使用何种类型的支架，经皮治疗大冠状动脉血管的临床事件风险都较低。
