Rodriguez Alfredo E, Maree Andrew O, Mieres Juan, Berrocal Daniel, Grinfeld Liliana, Fernandez-Pereira Carlos, Curotto Valeria, Rodriguez-Granillo Alfredo, O'Neill William, Palacios Igor F
Cardiovascular Research Center (CECI)/Sanatorio Otamendi, Callao 1441, 4B (1024), Buenos Aires, Argentina.
Eur Heart J. 2007 Sep;28(17):2118-25. doi: 10.1093/eurheartj/ehm297. Epub 2007 Jul 25.
Long-term benefit from coronary revascularization with drug-eluting stents (DES) relative to bare metal stents (BMS) and coronary artery bypass grafting (CABG) has not been established. One year follow-up of the ERACI III registry study showed better outcome with DES. To compare major adverse cardiac and cerebrovascular event (MACCE) rates in patients with multivessel cardiovascular disease (CVD) who received DES with those patients treated with BMS or CABG in the ERACI II trial.
Patients with multivessel CVD who met the ERACI II trial, clinical and angiographic inclusion criteria were treated with DES and enrolled in the ERACI III registry. The primary endpoint was 3-year MACCE. ERACI III-DES patients (n = 225) were compared with the BMS (n = 225) and CABG (n = 225) arms of ERACI II. Patients treated with DES were older, more often smokers, more often high risk by euroSCORE and less frequently had unstable angina. They also had higher incidence of type C lesions and received more stents than the BMS-treated cohort. Three year MACCE was lower in ERACI III-DES (22.7%) than in ERACI II-BMS (29.8%, P = 0.015), mainly reflecting less target vessel revascularization (14.2 vs. 24.4%, P = 0.009). MACCE rates at 3 years were similar in DES and CABG-treated patients (22.7%, P = 1.0), in contrast to results at 1 year (12 vs. 19.6%, P = 0.038). MACCE rates in ERACI III-DES were higher in diabetics (RR 0.81, 0.66-0.99; P = 0.018). Death or non-fatal MI at 3 years trended higher in the DES (10.2%) than BMS cohort (6.2%, P = 0.08) and lower than in CABG patients (15.1%, P = 0.07). Sub-acute late-stent thrombosis (LST) (>30 days) occurred in nine DES patients and no BMS patients (P = 0.008).
In patients with multivessel CVD, the initial advantage for PCI with DES over CABG observed at 1 year was not apparent by 3 years. Furthermore, despite continued lower incidence of MACCE, initial advantage over BMS appeared to decrease with time. LST occurred more frequent in DES-treated patients.
药物洗脱支架（DES）相对于裸金属支架（BMS）和冠状动脉旁路移植术（CABG）进行冠状动脉血运重建的长期获益尚未明确。ERACI III注册研究的一年随访显示DES有更好的结果。比较接受DES治疗的多支血管心血管疾病（CVD）患者与在ERACI II试验中接受BMS或CABG治疗的患者的主要不良心脑血管事件（MACCE）发生率。
符合ERACI II试验临床和血管造影纳入标准的多支血管CVD患者接受DES治疗并纳入ERACI III注册研究。主要终点是3年MACCE。将ERACI III-DES组患者（n = 225）与ERACI II试验的BMS组（n = 225）和CABG组（n = 225）进行比较。接受DES治疗的患者年龄更大，吸烟者更多，根据欧洲心脏手术风险评估系统（EuroSCORE）评估为高危的情况更常见，不稳定型心绞痛的发生率更低。他们C型病变的发生率也更高，且比接受BMS治疗的队列置入的支架更多。ERACI III-DES组3年MACCE发生率（22.7%）低于ERACI II-BMS组（29.8%，P = 0.015），主要反映为靶血管血运重建较少（14.2%对24.4%，P = 0.009）。DES和CABG治疗患者3年MACCE发生率相似（22.7%，P = 1.0），这与1年时的结果相反（12%对19.6%，P = 0.038）。ERACI III-DES组糖尿病患者的MACCE发生率更高（相对危险度0.81，0.66 - 0.99；P = 0.018）。3年时DES组死亡或非致死性心肌梗死发生率（10.2%）高于BMS组（6.2%，P = 0.08），低于CABG组患者（15.1%，P = 0.07）。9例DES患者发生亚急性晚期支架血栓形成（LST）（>30天），BMS组无患者发生（P = 0.008）。
在多支血管CVD患者中，1年时观察到的DES用于经皮冠状动脉介入治疗（PCI）相对于CABG的初始优势在3年时并不明显。此外，尽管MACCE发生率持续较低，但相对于BMS的初始优势似乎随时间降低。DES治疗患者中LST发生更频繁。
