药物洗脱支架时代冠状动脉多支血管病变的血运重建策略：ERACI III试验的一年随访结果

Revascularization strategies of coronary multiple vessel disease in the Drug Eluting Stent Era: one year follow-up results of the ERACI III Trial.

作者信息

Rodriguez Alfredo E, Grinfeld Liliana, Fernandez-Pereira Carlos, Mieres Juan, Rodriguez Alemparte Maximo, Berrocal Daniel, Rodriguez-Granillo Alfredo M, Vigo Cesar F, Russo Felsen Miguel, O'Neill William, Palacios Igor

机构信息

Otamendi Hospital, CECI, Buenos Aires, Argentina.

出版信息

EuroIntervention. 2006 May;2(1):53-60.

PMID:19755237

Abstract

OBJECTIVE

To compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) in patients with multiple vessel coronary artery disease treated with drug eluted stents (DES), bare metal stents, percutaneous coronary interventions (PCI) or bypass surgery (CABG).

METHODS

In the Argentine Randomized Study Coronary Angioplasty versus Coronary Bypass Surgery in Multiple Vessel Disease (ERACI) III trial, 225 patients with multivessel disease who received DES met clinical and angiographic inclusion criteria for the ERACI II trial. This cohort (ERACI III-DES) was compared to both ERACI II treatment arms (ERACII-PCI and ERACI II-CABG). The primary end point was freedom from MACCE at one year.

RESULTS

Comparison of baseline demographic and angiographic data, revealed that ERACI III-DES patients were older, smoked more, had more diabetes, hyperlipidaemia, hypertension, type C lesions and received more stents. At one year freedom from MACCE was significantly greater in ERACI III-DES cohort (88%) than ERACI II CABG (80.5% p=0.038) and ERACI II PCI (78% p=0.006) patients. The ERACI III-DES cohort had similar freedom from death and acute myocardial infarction (AMI) to ERACI II PCI patients but greater than ERACI II-CABG arm. Freedom from repeat revascularization was similar between ERACI III-DES to ERACI II-CABG (95.1% p=ns) patients, but both were significantly better than those in the ERACI II-PCI arm ( 91.2% and 83%p=0.002 and 0.02 respectively).

CONCLUSION

Patients with multiple vessel disease treated with DES in ERACI III had better one year outcomes than those treated with PCI or CABG in ERACI II.

摘要

目的

比较接受药物洗脱支架（DES）、裸金属支架、经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的多支冠状动脉疾病患者的主要不良心脑血管事件（MACCE）发生率。

方法

在阿根廷多支血管疾病冠状动脉血管成形术与冠状动脉旁路移植术随机研究（ERACI）III试验中，225例接受DES且符合ERACI II试验临床和血管造影纳入标准的多支血管疾病患者。该队列（ERACI III-DES）与ERACI II的两个治疗组（ERACII-PCI和ERACI II-CABG）进行比较。主要终点是一年时无MACCE。

结果

基线人口统计学和血管造影数据比较显示，ERACI III-DES患者年龄更大、吸烟更多、糖尿病、高脂血症、高血压、C型病变更多且接受的支架更多。一年时，ERACI III-DES队列中无MACCE的比例（88%）显著高于ERACI II CABG组（80.5%，p=0.038）和ERACI II PCI组（78%，p=0.006）患者。ERACI III-DES队列的无死亡和急性心肌梗死（AMI）发生率与ERACI II PCI患者相似，但高于ERACI II-CABG组。ERACI III-DES与ERACI II-CABG患者的无再次血运重建率相似（95.1%，p=无显著性差异），但两者均显著优于ERACI II-PCI组（分别为91.2%和83%，p=0.002和0.02）。