Ruiz-Nodar Juan M, Marín Francisco, Sánchez-Payá José, Hurtado José A, Valencia-Martín José, Manzano-Fernández Sergio, Roldán Vanessa, Pérez-Andreu Virginia, Sogorb Francisco, Valdés Mariano, Lip Gregory Y H
Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain.
Eur Heart J. 2009 Apr;30(8):932-9. doi: 10.1093/eurheartj/ehp045. Epub 2009 Feb 26.
Drug-eluting stents (DES) have never been sufficiently studied in patients with atrial fibrillation (AF). The latter are considered as a high-risk population with uncertainty over the optimal antithrombotic therapy strategy to prevent stroke, stent thrombosis, and recurrent cardiac ischaemia, balanced against the high risk of haemorrhage. The aim of this study was to evaluate the safety and efficacy of the use of DES vs. bare-metal stents (BMS) in a cohort of patients with AF.
We reviewed 604 patients with AF who had undergone percutaneous coronary intervention with stent over a period of 7 years (January 2001-January 2008). After a propensity score selection, we identified two matched cohorts who received DES (n = 207) or BMS (n = 207). Clinical follow-up was performed, and all bleeding episodes, thrombo-embolism, and major adverse cardiac events (MACE; i.e. death, acute myocardial infarction, target vessel failure) were recorded. Complete follow-up was achieved in 95.9% of the cohort (mean: 693 +/- 427 days, median: 564). The incidence density of MACE as well as the incidence of all-cause mortality in both groups was similar. There was a higher incidence of major bleeding in DES group (2.26 vs. 1.19 per 10 000 days of exposure; P = 0.03). In a multivariate analysis, age, chronic AF, chronic renal failure, and non-use of dicoumarin were predictors of MACE and of all-cause mortality. The use of DES was not a predictor of reduced events.
On the basis of this study, the routine use of DES in patients with AF does not seem to be justified. A higher risk of major bleeding with DES in comparison with BMS raises the possibility that DES should be limited to lesions or patients with a high risk of restenosis.
药物洗脱支架（DES）在心房颤动（AF）患者中尚未得到充分研究。后者被视为高危人群，在预防中风、支架血栓形成和复发性心脏缺血的最佳抗栓治疗策略方面存在不确定性，同时还要平衡出血的高风险。本研究的目的是评估在AF患者队列中使用DES与裸金属支架（BMS）的安全性和有效性。
我们回顾了604例在7年期间（2001年1月至2008年1月）接受了支架植入的经皮冠状动脉介入治疗的AF患者。经过倾向评分选择后，我们确定了两个匹配队列，分别接受DES（n = 207）或BMS（n = 207）。进行了临床随访，并记录了所有出血事件、血栓栓塞和主要不良心脏事件（MACE，即死亡、急性心肌梗死、靶血管失败）。95.9%的队列实现了完整随访（平均：693±427天，中位数：564天）。两组的MACE发病率密度以及全因死亡率相似。DES组的大出血发生率较高（每暴露10000天为2.26例 vs. 1.19例；P = 0.03）。在多变量分析中，年龄、慢性AF、慢性肾功能衰竭和未使用双香豆素是MACE和全因死亡率的预测因素。使用DES不是事件减少的预测因素。
基于本研究，在AF患者中常规使用DES似乎不合理。与BMS相比，DES大出血风险更高，这增加了DES应仅限于病变或再狭窄高危患者的可能性。
