Burzotta Francesco, Trani Carlo, Todaro Daniel, Mazzari Mario Attilio, Porto Italo, De Vita Maria, Brugaletta Salvatore, Coroleu Santiago Federico, Niccoli Giampaolo, Leone Antonio Maria, Giammarinaro Maura, Mongiardo Rocco, Schiavoni Giovanni, Crea Filippo
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Catheter Cardiovasc Interv. 2009 Mar 1;73(4):457-65. doi: 10.1002/ccd.21882.
To investigate the outcome of patients undergoing percutaneous coronary interventions (PCI) with implantation of a new thin-strut cobalt-chromium bare-metal-stent (BMS) in the drug-eluting-stent (DES) era.
Despite the contemporary penetration of DES in the clinical practice, a relevant percentage of patients are still treated by BMS. Data on clinical outcome of novel BMSs are lacking.
This is a single-centre-registry enrolling patients treated by Skylor stent implantation. During the study, the criteria for BMS selection adopted at our institution ("internal" criteria) were as follows: (1) limited compliance to prolonged double antiplatelet therapy, (2) ST-elevation myocardial infarction (STEMI) or saphenous vein grafts (SVG) interventions, and (3) in the absence of these conditions, noncomplex (no bifurcations, no chronic total occlusions) lesions considered at low restenosis risk on the basis of arbitrary angiographic criteria (short lesions, large vessels). Primary and secondary end-points were respectively major adverse cardiovascular events (MACE) and target vessel failure (TVF) up to 9-month.
A total of 150 patients were treated with Skylor stent on 169 lesions. At 9-month follow-up, MACE occurred in 12 patients (8.0%) and TVF in 21 lesions (12.4%). By multivariable analysis, the predictors of MACE were Euroscore>or=9 and ejection fraction < 30% while the predictors of TVF were the absence of the angiographic criteria of low restenosis risk and ejection fraction < 30%.
In the DES era, the use of a last-generation BMS in patients with limited compliance to double antiplatelet therapy, STEMI or SVG interventions, and noncomplex angiographic lesions may be associated with acceptable clinical outcome.
在药物洗脱支架(DES)时代,研究接受经皮冠状动脉介入治疗(PCI)并植入新型薄支柱钴铬裸金属支架(BMS)患者的预后情况。
尽管DES在临床实践中已广泛应用,但仍有相当比例的患者接受BMS治疗。目前缺乏新型BMS临床预后的数据。
这是一项单中心注册研究,纳入接受Skylor支架植入治疗的患者。在研究期间,我们机构采用的BMS选择标准(“内部”标准)如下:(1)对延长双联抗血小板治疗依从性有限;(2)ST段抬高型心肌梗死(STEMI)或大隐静脉桥血管(SVG)介入治疗;(3)在无上述情况时,根据任意血管造影标准(病变短、血管大)被认为再狭窄风险低的非复杂病变(无分叉、无慢性完全闭塞)。主要终点和次要终点分别为9个月内的主要不良心血管事件(MACE)和靶血管失败(TVF)。
共150例患者的169处病变接受了Skylor支架治疗。在9个月的随访中,12例患者(8.0%)发生MACE,21处病变(12.4%)发生TVF。多变量分析显示,MACE的预测因素为欧洲心脏手术风险评估系统(Euroscore)≥9分和射血分数<30%,而TVF的预测因素为缺乏低再狭窄风险的血管造影标准和射血分数<30%。
在DES时代,对于双联抗血小板治疗依从性有限、STEMI或SVG介入治疗以及血管造影病变不复杂的患者,使用新一代BMS可能会有可接受的临床预后。