Yan Bryan P, Duffy Stephen J, Clark David J, Lefkovits Jeffery, Warren Roderic, Gurvitch Ronen, Lew Robert, Sebastian Martin, Brennan Angela, Andrianopoulos Nick, Reid Christopher M, Ajani Andrew E
Cardiology Division, Section of Vascular Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Am J Cardiol. 2008 Jun 15;101(12):1716-22. doi: 10.1016/j.amjcard.2008.02.058. Epub 2008 Apr 9.
Recent reports suggest that drug-eluting stents (DESs) may increase the risk of stent thrombosis (ST) relative to bare-metal stents (BMSs). Therefore, the aim of this study was to compare DES and BMS outcomes with a specific focus on ST. We analyzed 30-day and 1-year outcomes of 2,919 patients who underwent percutaneous coronary intervention with stent implantation from the Melbourne Interventional Group registry. Academic Research Consortium definitions of ST were used: (1) definite ST (confirmed using angiography in patients with an acute coronary syndrome), (2) probable ST (unexplained death <30 days or target-vessel myocardial infarction without angiographic confirmation), and (3) possible ST (unexplained death >30 days). Multivariate analysis was performed to identify predictors of ST. The incidence of ST (early or late) was similar between BMSs and DESs (1.6% vs 1.4%; p=0.66), and DES use was not predictive of ST. Independent predictors of ST included the absence of clopidogrel therapy at 30 days (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.29 to 5.29, p<0.01), renal failure (OR 3.30, 95% CI 1.43 to 7.59, p<0.01), index procedure presentation with an acute coronary syndrome (OR 2.59, 95% CI 1.14 to 5.87, p=0.02), diabetes mellitus (OR 2.25, 95% CI 1.19 to 4.23, p=0.01), and total stent length >or=20 mm (OR 1.85, 95% CI 1.00 to 3.42, p=0.04). In conclusion, DESs were not associated with increased risk of ST compared with BMSs at 12 months in this large Australian registry that selectively used DESs for patients at high risk of restenosis.
近期报告显示，与裸金属支架（BMS）相比，药物洗脱支架（DES）可能会增加支架血栓形成（ST）的风险。因此，本研究的目的是比较DES和BMS的治疗结果，特别关注ST。我们分析了墨尔本介入治疗组登记处2919例行支架植入经皮冠状动脉介入治疗患者的30天和1年治疗结果。采用学术研究联盟对ST的定义：（1）明确的ST（在急性冠状动脉综合征患者中通过血管造影确诊），（2）可能的ST（不明原因死亡<30天或无血管造影证实的靶血管心肌梗死），以及（3）可能的ST（不明原因死亡>30天）。进行多变量分析以确定ST的预测因素。BMS和DES的ST发生率（早期或晚期）相似（1.6%对1.4%；p = ０.66），使用DES不能预测ST。ST的独立预测因素包括30天时未使用氯吡格雷治疗（比值比[OR]2.58，95%置信区间[CI]1.29至5.29，p<0.01）、肾衰竭（OR 3.30，95%CI 1.43至7.59，p<0.01）、急性冠状动脉综合征作为首次手术表现（OR 2.59，95%CI 1.14至5.87，p = 0.02）、糖尿病（OR 2.25，95%CI 1.19至4.23，p = 0.01）以及总支架长度≥20 mm（OR 1.85，95%CI 1.00至3.42，p = 0.04）。总之，在这个为再狭窄高危患者选择性使用DES的大型澳大利亚登记处中，与BMS相比，DES在12个月时与ST风险增加无关。
