Kaplan Sahin, Barlis Peter, Kiris Abdulkadir, Dimopoulos Konstantinos, Celik Sukru, Di Mario Carlo
Royal Brompton Hospital, Department of Cardiology, London, UK.
Acute Card Care. 2008;10(2):88-92. doi: 10.1080/17482940701885400.
Ostial saphenous vein graft (OSVG) lesions were excluded from all the clinical trials demonstrating significantly lower restenosis rates with drug-eluting stents (DES) compared to bare metal stents (BMS). This study aimed to evaluate the efficacy of DES in OSVG lesions by assessing angiographic and 12-month clinical outcomes.
70 consecutive patients (70 OSVG lesions) underwent coronary stent implantation between May 2003 and April 2006: 37 lesions received DES and 33 lesions BMS. Endpoints were all cause and cardiovascular mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), examined separately and as a combined end-point (major adverse cardiac events, MACE).
Procedural (94.6% for DES and 87.9% for BMS) and angiographic (100% for DES and 100% for BMS) success did not differ between the two groups. The only in-hospital events were non-Q wave MI (DES 8.1% versus BMS 12.1%, P=0.69). At 30-day follow-up, there were no other events. Overall, at 1-year follow-up, the BMS group had a higher TLR (30.3% versus 5.4%, P=0.015), TVR (33.3% versus 10.8%, P=0.045) and MACE rate (36.4% versus 10.8%, P=0.024) compared to the DES group.
Drug-eluting stent implantation to OSVG lesions achieves better clinical results than BMS but is still associated with a relatively high incidence (10.8%) of revascularization at 1-year follow-up.
在所有显示药物洗脱支架（DES）与裸金属支架（BMS）相比再狭窄率显著降低的临床试验中，均排除了开口处大隐静脉移植血管（OSVG）病变。本研究旨在通过评估血管造影和12个月的临床结局来评价DES治疗OSVG病变的疗效。
2003年5月至2006年4月期间，70例连续患者（70处OSVG病变）接受了冠状动脉支架植入术：37处病变接受DES治疗，33处病变接受BMS治疗。终点指标为全因死亡率和心血管死亡率、心肌梗死（MI）、靶病变血运重建（TLR）、靶血管血运重建（TVR），分别进行检查并作为复合终点（主要不良心脏事件，MACE）。
两组之间的手术成功率（DES为94.6%，BMS为87.9%）和血管造影成功率（DES和BMS均为100%）无差异。唯一的院内事件是非Q波MI（DES为8.1%，BMS为12.1%，P=0.69）。在30天随访时，无其他事件。总体而言，在1年随访时，与DES组相比，BMS组的TLR（30.3%对5.4%，P=0.015）、TVR（33.3%对10.8%，P=0.045）和MACE发生率（36.4%对10.8%，P=0.024）更高。
在OSVG病变中植入药物洗脱支架比BMS能取得更好的临床效果，但在1年随访时仍有相对较高的血运重建发生率（10.8%）。
