与裸金属支架相比，药物洗脱支架无保护左主干冠状动脉支架置入术的长期安全性和有效性。
Long-term safety and effectiveness of unprotected left main coronary stenting with drug-eluting stents compared with bare-metal stents.
作者信息
Kim Young-Hak, Park Duk-Woo, Lee Seung-Whan, Yun Sung-Cheol, Lee Cheol Whan, Hong Myeong-Ki, Park Seong-Wook, Seung Ki Bae, Gwon Hyeon-Cheol, Jeong Myung-Ho, Jang Yangsoo, Kim Hyo-Soo, Seong In-Whan, Park Hun Sik, Ahn Taehoon, Chae In-Ho, Tahk Seung-Jea, Chung Wook-Sung, Park Seung-Jung
机构信息
Asan Medical Center, Seoul, South Korea.
出版信息
Circulation. 2009 Aug 4;120(5):400-7. doi: 10.1161/CIRCULATIONAHA.108.800805. Epub 2009 Jul 20.
BACKGROUND
Limited information is available on long-term outcomes for patients with unprotected left main coronary artery disease who received drug-eluting stents (DES).
METHODS AND RESULTS
In the multicenter registry evaluating outcomes among patients with unprotected left main coronary artery stenosis undergoing stenting with either bare metal stents (BMS) or DES, 1217 consecutive patients were divided into 2 groups: 353 who received only BMS and 864 who received at least 1 DES. The 3-year outcomes were compared by use of the adjustment of inverse-probability-of-treatment-weighted method. Patients receiving DES were older and had a higher prevalence of diabetes mellitus, hypertension, hyperlipidemia, and multivessel disease. In the overall population, with the use of DES, the 3-year adjusted risk of death (8.0% versus 9.5%; hazard ratio, 0.71; 95% confidence interval, 0.36 to 1.40; P=0.976) or death or myocardial infarction (14.3% versus 14.9%; hazard ratio, 0.83; 95% confidence interval, 0.49 to 1.40; P=0.479) was similar compared with BMS. However, the risk of target lesion revascularization was significantly lower with the use of DES than BMS (5.4% versus 12.1%; hazard ratio, 0.40; 95% confidence interval, 0.22 to 0.73; P=0.003). When patients were classified according to lesion location, DES was still associated with lower risk of target lesion revascularization in patients with bifurcation (6.9% versus 16.3%; hazard ratio, 0.38; 95% confidence interval, 0.18 to 0.78; P=0.009) or nonbifurcation (3.4% versus 10.3%; hazard ratio, 0.39; 95% confidence interval, 0.17 to 0.88; P=0.024) lesions with a comparable risk of death or myocardial infarction.
CONCLUSIONS
Compared with BMS, DES was associated with a reduction in the need for repeat revascularization without increasing the risk of death or myocardial infarction for patients with unprotected left main coronary artery stenosis.
背景
关于接受药物洗脱支架（DES）治疗的无保护左主干冠状动脉疾病患者的长期预后信息有限。
方法与结果
在一项评估接受裸金属支架（BMS）或DES置入术的无保护左主干冠状动脉狭窄患者预后的多中心注册研究中，1217例连续患者被分为两组：353例仅接受BMS治疗，864例接受至少1枚DES治疗。采用逆概率加权法进行调整后比较3年预后。接受DES治疗的患者年龄更大，糖尿病、高血压、高脂血症和多支血管病变的患病率更高。在总体人群中，使用DES时，3年调整后的死亡风险（8.0%对9.5%；风险比，0.71；95%置信区间，0.36至1.40；P = 0.976）或死亡或心肌梗死风险（14.3%对14.9%；风险比，0.83；95%置信区间，0.49至1.40；P = 0.479）与BMS相似。然而，使用DES时靶病变血运重建的风险显著低于BMS（5.4%对12.1%；风险比，0.40；95%置信区间，0.22至0.73；P = 0.003）。当根据病变部位对患者进行分类时，DES在分叉病变（6.9%对16.3%；风险比，0.38；95%置信区间，0.18至0.78；P = 0.009）或非分叉病变（3.4%对10.3%；风险比，0.39；95%置信区间，0.17至0.88；P = 0.024）患者中，死亡或心肌梗死风险相当的情况下，仍与较低的靶病变血运重建风险相关。
结论
与BMS相比，DES与无保护左主干冠状动脉狭窄患者重复血运重建需求的减少相关，且不增加死亡或心肌梗死风险。
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