药物洗脱支架与裸金属支架植入治疗慢性完全性冠状动脉闭塞患者的长期预后

Long-term outcomes of drug-eluting versus bare-metal stent implantation in patients with chronic total coronary artery occlusions.

作者信息

Han Ya-Ling, Zhang Jian, Li Yi, Wang Shou-Li, Jing Quan-Min, Yi Xian-Hua, Ma Ying-Yan, Luan Bo, Wang Geng, Wang Bin

机构信息

Department of Cardiology, Shenyang Northern Hospital, Shenyang, Liaoning 110016, China.

出版信息

Chin Med J (Engl). 2009 Mar 20;122(6):643-7.

PMID:19323927

Abstract

BACKGROUND

There are limited data on the efficacy of drug-eluting stents (DES) for treatment of chronic total occlusions (CTO). The aim of the study was to evaluate the long-term clinical outcomes of DES implantation for CTO compared with bare-metal stent (BMS) implantation.

METHODS

Between June 1995 and December 2006, a total of 1184 patients with successful recanalization of at least one de novo CTO lesion were consecutively registered, including 660 (55.7%) who underwent DES and 524 (44.3%) who underwent BMS implantation. All patients were followed up for up to 5 years for occurrence of major adverse cardiac events (MACE). Long-term survival rates were estimated with the Kaplan-Meier method.

RESULTS

Baseline clinical and angiographic characteristics were comparable between the two groups except that patients in the DES group received longer dual antiplatelet therapy ((7.4 +/- 2.5) months vs (1.7 +/- 0.8) months, P < 0.001). Average follow-up periods were (4.7 +/- 0.89) and (3.2 +/- 1.3) years for the BMS and DES groups, respectively. There was no significant difference in 5-year survival rates between the two groups (90.3% for DES group vs 89.6% for BMS group, Log-rank P = 0.38), but the 5-year target vessel revascularization (TVR)-free survival rate in the DES group was significantly higher than that in the BMS group (81.6% vs 73.5%, Log-rank P < 0.001). The cumulative MACE-free survival in the DES group was also significantly higher than that in the BMS group (80.6% vs 71.5%, Log-rank P < 0.001). The rates of re-admission caused by cardiovascular disease (27.0% vs 37.8%, P < 0.001) and the need for bypass surgery were significantly lower in the DES group (1.5% vs 3.4%, P < 0.05). By multivariable analysis, DES implantation could significantly lower the long-term MACE risk of PCI for CTO patients (HR: 0.492; 95% CI 0.396 - 0.656, P < 0.001). Left ventricular ejection fraction < 50% and elderly (> or = 65 years) were identified as independent predictors of long-term MACE during follow-up.

CONCLUSION

This study demonstrates the long-term (up to 5 years) efficacy of DES for treatment of CTO, which is superior to BMS implantation in reducing the rates of TVR and MACE, as well as the need of re-admission and bypass surgery.

摘要

背景

关于药物洗脱支架（DES）治疗慢性完全闭塞病变（CTO）疗效的数据有限。本研究的目的是评估与裸金属支架（BMS）植入相比，DES植入治疗CTO的长期临床结局。

方法

1995年6月至2006年12月，共连续登记了1184例至少成功再通一处初发CTO病变的患者，其中660例（55.7%）接受了DES植入，524例（44.3%）接受了BMS植入。所有患者均随访长达5年，观察主要不良心脏事件（MACE）的发生情况。采用Kaplan-Meier法估计长期生存率。

结果

两组患者的基线临床和血管造影特征具有可比性，但DES组患者接受双联抗血小板治疗的时间更长（（7.4±2.5）个月 vs （1.7±0.8）个月，P<0.001）。BMS组和DES组的平均随访时间分别为（4.7±0.89）年和（3.2±1.3）年。两组的5年生存率无显著差异（DES组为90.3%，BMS组为89.6%，Log-rank检验P=0.38），但DES组的5年无靶血管重建（TVR）生存率显著高于BMS组（81.6% vs 73.5%，Log-rank检验P<0.001）。DES组的累积无MACE生存率也显著高于BMS组（80.6% vs 71.5%，Log-rank检验P<0.001）。DES组因心血管疾病导致的再次入院率（27.0% vs 37.8%，P<0.001）和旁路手术需求显著更低（1.5% vs 3.4%，P<0.05）。通过多变量分析，DES植入可显著降低CTO患者PCI的长期MACE风险（HR：0.492；95%CI 0.396 - 0.656，P<0.001）。左心室射血分数<50%和老年患者（≥65岁）被确定为随访期间长期MACE的独立预测因素。