Ahmad Mayraj, Schwalm Jon-David R, Velianou James L, Pericak Dan, Natarajan Madhu K
Department of Medicine, McMaster University, Hamilton, Canada.
Can J Cardiol. 2008 Oct;24(10):771-5. doi: 10.1016/s0828-282x(08)70682-2.
In randomized trials, paclitaxel-eluting stents (PES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis. However, the effectiveness of PES in patients treated during routine practice has not been fully established.
A retrospective comparison of PES with BMS in consecutive patients undergoing percutaneous coronary intervention (PCI) from April 2003 to March 2004 was conducted. Outcomes included the composite of death, myocardial infarction and target lesion revascularization (TLR) at one year, as well as stent thrombosis.
A total of 512 patients were treated with PES, and 722 patients were treated with BMS. Patients in the PES group were more likely to receive stents that were 20 mm in length or longer (52.2% versus 33.3%, P<0.0001), 2.5 mm in diameter or smaller (29.1% versus 12.5%, P<0.0001) and implanted in bifurcation positions (15.4% versus 11.6%, P=0.02). At one year, the composite outcome of death, myocardial infarction and TLR was 6.1% in the PES group compared with 10.8% in the BMS group (P=0.004). The one-year rate of stent thrombosis was 0.59% in the PES group compared with 0.28% in the BMS group (P=0.4).
Despite being used in higher-risk lesions, there was a lower rate of major cardiac events at one year in patients treated with PES, primarily driven by the reduction in TLR. Thus, the experience with PES in contemporary practice applied to a broader population appears to be consistent with the results reported in randomized trials.
在随机试验中，紫杉醇洗脱支架（PES）在减少再狭窄方面已显示出优于裸金属支架（BMS）。然而，PES在常规临床治疗患者中的有效性尚未完全确立。
对2003年4月至2004年3月连续接受经皮冠状动脉介入治疗（PCI）的患者进行了PES与BMS的回顾性比较。结局指标包括1年时死亡、心肌梗死和靶病变血运重建（TLR）的复合终点，以及支架血栓形成。
共有512例患者接受了PES治疗，722例患者接受了BMS治疗。PES组患者更有可能接受长度为20 mm或更长的支架（52.2%对33.3%，P<0.0001）、直径为2.5 mm或更小的支架（29.1%对12.5%，P<0.0001），且支架植入于分叉部位的比例更高（15.4%对11.6%，P=0.02）。1年时，PES组死亡、心肌梗死和TLR的复合结局为6.1%，而BMS组为10.8%（P=0.004）。PES组1年的支架血栓形成率为0.59%，BMS组为0.28%（P=0.4）。
尽管PES用于更高风险的病变，但接受PES治疗的患者1年时主要心脏事件发生率较低，主要是由于TLR的减少。因此，当代临床实践中PES应用于更广泛人群的经验似乎与随机试验报告的结果一致。
