Lee Seung-Whan, Park Seong-Wook, Park Duk-Woo, Lee Se-Whan, Kim Sang-Hyun, Jang Jae-Sik, Jeong Yeong-Hoon, Kim Young-Hak, Lee Cheol Whan, Hong Myeong-Ki, Yun Seong-Chul, Kim Jae-Joong, Park Seung-Jung
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Am J Cardiol. 2007 Aug 1;100(3):425-30. doi: 10.1016/j.amjcard.2007.03.040. Epub 2007 Jun 13.
To evaluate long-term effectiveness of sirolimus-eluting stent (SES) implantation for diffuse bare metal in-stent restenosis (ISR), we compared 6-month angiographic and long-term (3-year) clinical outcomes of SES implantation and intracoronary brachytherapy (ICBT). SES implantation for diffuse ISR was performed in 120 consecutive patients and their results were compared with those from 240 patients treated with beta-radiation with balloons filled with rhenium-188 and mercaptoacetyltriglycine. The radiation dose was 15 or 18 Gy at a depth of 1.0 mm into the vessel wall. The primary end point was 3-year major adverse cardiac events including myocardial infarction, cardiac death, and target lesion revascularization. The 2 groups were similar in baseline clinical and angiographic characteristics. Lesion lengths were 25.1 +/- 14.2 mm in the SES group and 24.5 +/- 10.4 mm in the ICBT group (p = 0.15). In-stent acute gain was greater in the SES group than in the ICBT group (2.23 +/- 0.62 vs 1.91 +/- 0.54 mm, p <0.001). We obtained 6-month angiographic follow-up in 287 patients (79.7%). In-segment angiographic restenoses were 7.4% (7 of 94) in the SES group and 26.4% (51 of 193) in the ICBT group (p <0.05). Two myocardial infarctions (1 in each group) and 5 deaths (4 in SES group, 1 in ICBT group) occurred during 3-year follow-up. At 3 years, survival rates without target lesion revascularization (94.1 +/- 2.2% vs 84.6 +/- 2.3%, p = 0.011) and major adverse cardiac events (92.5 +/- 2.4% vs 84.2 +/- 2.4%, respectively, p = 0.03) were higher in the SES than in the ICBT group. In conclusion, compared with ICBT, SES implantation for diffuse ISR is more effective in decreasing recurrent restenosis and improving long-term outcomes.
为评估西罗莫司洗脱支架（SES）植入治疗弥漫性裸金属支架内再狭窄（ISR）的长期疗效，我们比较了SES植入与冠状动脉内近距离放射治疗（ICBT）的6个月血管造影结果和长期（3年）临床结局。对120例连续患者进行了弥漫性ISR的SES植入，并将其结果与240例接受用填充铼-188和巯基乙酰三甘氨酸的球囊进行β射线放射治疗的患者的结果进行比较。血管壁内1.0 mm深度处的放射剂量为15或18 Gy。主要终点是3年主要不良心脏事件，包括心肌梗死、心源性死亡和靶病变血管重建。两组在基线临床和血管造影特征方面相似。SES组病变长度为25.1±14.2 mm，ICBT组为24.5±10.4 mm（p = 0.15）。SES组支架内急性增益大于ICBT组（2.23±0.62 vs 1.91±0.54 mm，p<0.001）。我们对287例患者（79.7%）进行了6个月的血管造影随访。SES组节段内血管造影再狭窄率为7.4%（94例中的7例），ICBT组为26.4%（193例中的51例）（p<0.05）。在3年随访期间发生了2例心肌梗死（每组1例）和5例死亡（SES组4例，ICBT组1例）。3年时，SES组无靶病变血管重建的生存率（94.1±2.2% vs 84.6±2.3%，p = 0.011）和主要不良心脏事件发生率（分别为92.5±2.4% vs 84.2±2.4%，p = 0.03）高于ICBT组。总之，与ICBT相比，SES植入治疗弥漫性ISR在降低复发性再狭窄和改善长期结局方面更有效。
