Okabe Teruo, Lindsay Joseph, Torguson Rebecca, Steinberg Daniel H, Roy Probal, Slottow Tina L Pinto, Kaneshige Kimberly, Xue Zhenyi, Satler Lowell F, Kent Kenneth M, Pichard Augusto D, Waksman Ron
Washington Hospital Center, Washington, DC 20010, USA.
Catheter Cardiovasc Interv. 2008 Nov 15;72(6):799-803. doi: 10.1002/ccd.21678.
Distal embolization during percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) lesions is associated with a high rate of myonecrosis. Although direct stenting (DS) is feasible with less catheter manipulations, its ability to prevent distal embolization in SVG lesions compared with distal protection devices (DPD) is unknown.
The study included 188 SVG lesions subjected to PCI, 101 patients with 101 lesions treated with DPD, and 87 patients with 87 lesions by DS without DPD. Major adverse cardiovascular events (MACE) in-hospital and at 30 days were compared.
Baseline characteristics were comparable, except for higher frequencies of unstable angina (53% vs. 67%, P = 0.045) and prior myocardial infarction (38% vs. 53%, P = 0.07) in the DS group. There was no difference in lesion type aside from more restenotic lesions in the DS group (7% vs. 16%, P = 0.047). Drug-eluting stent deployment was similar. Stent length in the DPD group (22.8 +/- 7.2 mm) was significantly longer than that in the DS group (17.6 +/- 8.0 mm, P < 0.001). Although maximum creatine kinase (CK)-MB value in the DPD group (2.5 +/- 5.8 ng/ml) was significantly larger than in the DS group (1.3 +/- 1.5 ng/ml, P = 0.039), the frequency of CK-MB rise >2 times the upper limit of normal did not differ (11% vs. 6%, P = 0.2). There were no differences in MACE rates in-hospital and at 30 days. By multivariate analysis, neither DPD nor DS was a significant predictor for maximum CK-MB value.
DS should be considered an alternative treatment to PCI with DPD for selected SVG lesions.
在隐静脉桥（SVG）病变的经皮冠状动脉介入治疗（PCI）过程中，远端栓塞与较高的心肌坏死发生率相关。尽管直接支架置入术（DS）通过较少的导管操作是可行的，但其与远端保护装置（DPD）相比预防SVG病变远端栓塞的能力尚不清楚。
该研究纳入了188例接受PCI的SVG病变，101例患者的101个病变采用DPD治疗，87例患者的87个病变采用无DPD的DS治疗。比较了住院期间和30天时的主要不良心血管事件（MACE）。
除DS组不稳定型心绞痛（53%对67%，P = 0.045）和既往心肌梗死（38%对53%，P = 0.07）的发生率较高外，基线特征具有可比性。除DS组再狭窄病变较多（7%对16%，P = 0.047）外，病变类型无差异。药物洗脱支架的置入情况相似。DPD组的支架长度（22.8±7.2 mm）显著长于DS组（17.6±8.0 mm，P < 0.001）。尽管DPD组的最大肌酸激酶（CK）-MB值（2.5±5.8 ng/ml）显著高于DS组（1.3±1.5 ng/ml，P = 0.039），但CK-MB升高超过正常上限2倍的频率无差异（11%对6%，P = 0.2）。住院期间和30天时的MACE发生率无差异。通过多因素分析，DPD和DS均不是最大CK-MB值的显著预测因素。
对于选定的SVG病变，DS应被视为PCI联合DPD的替代治疗方法。
