Cardiovascular Center, Korea University Guro Hospital, 97 Gurodong-Gil, Guro-Gu, Seoul 152 703, Republic of Korea.
J Cardiol. 2009 Aug;54(1):108-14. doi: 10.1016/j.jjcc.2009.05.004. Epub 2009 Jun 13.
Although drug-eluting stents (DES) have been shown to dramatically reduce restenosis and improve the rate of event-free survival in large randomized trials, the benefit of DES appears to be limited to restenosis. In large arteries, it is not clear which type of stent is more superior in angiographic and clinical outcomes between DES and bare-metal stents (BMS). We compared the angiographic and clinical outcomes of DES versus BMS in large arteries (> or = 3.5 mm).
Two hundred and forty patients from March 2002 to March 2007 received stents; 196 patients were treated with DES (44.9% sirolimus-eluting stents; 43.9% paclitaxel-eluting stents; 11.2% zotarolimus-eluting stents) and 44 with cobalt-chromium BMS for single de novo lesions in a large vessel. All subjects received aspirin, clopidogrel, and/or cilostazol as the standard antiplatelet regimen. The angiographic and clinical outcomes were evaluated at 6 months.
For the baseline characteristics, there were no significant differences between the DES and BMS groups. In addition, for the initially implanted stent there was no difference in the length, stent diameter, and lesion site between the two groups. After 6 months, the follow-up angiogram showed that in-stent diameter restenosis and late loss was more common with BMS than DES (39+/-21% vs. 19+/-17%, p=0.007; 1.44+/-0.83 mm vs. 0.62+/-0.58 mm, p=0.009, respectively). However, the target-lesion revascularization/target-vessel revascularization, and total major adverse cardiac events showed no significant differences between the groups (5.3% vs. 3.6%, p=0.62; 5.3% vs. 4.6%, p=0.86, respectively).
The DES and cobalt-chromium BMS placed in large coronary arteries showed equally favorable 6-month clinical outcomes, although the 6-month angiographic results appeared more favorable in the DES group than in the BMS group.
虽然药物洗脱支架（DES）已被证明可显著降低再狭窄率并提高无事件生存率，但DES 的益处似乎仅限于再狭窄。在大血管中，DES 和裸金属支架（BMS）在血管造影和临床结局方面哪种支架更优越尚不清楚。我们比较了 DES 和 BMS 在大血管（>或=3.5mm）中的血管造影和临床结局。
2002 年 3 月至 2007 年 3 月，240 例患者接受支架治疗；196 例患者接受 DES（44.9%西罗莫司洗脱支架；43.9%紫杉醇洗脱支架；11.2%佐他莫司洗脱支架）治疗，44 例患者在大血管中单处病变接受钴铬 BMS 治疗。所有患者均接受阿司匹林、氯吡格雷和/或西洛他唑作为标准抗血小板治疗。在 6 个月时评估血管造影和临床结局。
对于基线特征，DES 和 BMS 组之间无显著差异。此外，两组之间最初植入的支架长度、支架直径和病变部位无差异。6 个月后，随访血管造影显示 BMS 组的支架内直径再狭窄和晚期丢失比 DES 组更常见（39+/-21%比 19+/-17%，p=0.007；1.44+/-0.83mm 比 0.62+/-0.58mm，p=0.009）。然而，两组之间的靶病变血运重建/靶血管血运重建和主要不良心脏事件总发生率无显著差异（5.3%比 3.6%，p=0.62；5.3%比 4.6%，p=0.86）。
DES 和钴铬 BMS 置入大冠状动脉后 6 个月的临床结局同样良好，尽管 DES 组的 6 个月血管造影结果似乎优于 BMS 组。
