Wake Forest University School of Medicine, Section of Cardiology, Winston-Salem, NC 27157-1045, USA.
Circ Cardiovasc Interv. 2009 Feb;2(1):35-42. doi: 10.1161/CIRCINTERVENTIONS.108.805630. Epub 2009 Feb 10.
The risk of restenosis and other adverse cardiac events with bare-metal stents (BMS) is increased with smaller stent diameters and longer stent lengths. Drug-eluting stents (DES) may reduce this effect in select patients; however, whether this benefit occurs in high-risk lesions and patients in routine practice is not clear.
Clinical outcomes (target-vessel revascularization [TVR], stent thrombosis, nonfatal myocardial infarction [MI], and cardiac death) at 2 years stratified by stented length and diameter were compared in 949 consecutive patients who received BMS and 1236 consecutive and comparable patients who received DES for single lesions. The longest tertile of BMS (>23 mm) was associated with increased hazard of TVR, ST, and nonfatal MI or death compared with shorter tertiles of BMS, which was abolished by DES. DES compared with BMS was independently associated with a lower hazard of TVR (HR, 0.34 [0.20 to 0.58]) and nonfatal MI or death (HR, 0.60 [0.39 to 0.92]) in the longest length tertile (>23 mm). No clear association of stented tertile diameter and clinical outcomes for either stent type was observed. However, DES compared with BMS was independently associated with a lower hazard of TVR for all diameter tertiles, and a lower hazard of nonfatal MI or death (0.66 [0.44 to 0.99]) in the largest diameter tertile (>3.4 mm).
Independent of adverse patient and lesion characteristics, DES demonstrated significantly lower hazard of TVR and nonfatal MI or death at 2 years compared with BMS within the longest stented lengths (>23 mm) and largest diameters (>3.4 mm).
裸金属支架（BMS）的支架直径较小和支架长度较长会增加再狭窄和其他不良心脏事件的风险。药物洗脱支架（DES）可能会降低某些患者的这种风险；然而，在常规实践中，这种益处是否发生在高危病变和患者中尚不清楚。
在接受 BMS 的 949 例连续患者和接受 DES 的 1236 例连续且可比患者中，根据支架长度和直径分层比较了 2 年时的临床结局（靶血管血运重建[TVR]、支架血栓形成、非致死性心肌梗死[MI]和心脏死亡）。最长的 BMS 三分位数（>23mm）与较短的 BMS 三分位数相比，TVR、ST 和非致死性 MI 或死亡的风险增加，DES 则消除了这种风险。DES 与 BMS 独立相关，与最长长度三分位数（>23mm）相比，TVR 的风险降低（HR，0.34[0.20 至 0.58]）和非致死性 MI 或死亡的风险降低（HR，0.60[0.39 至 0.92]）。对于这两种支架类型，均未观察到支架三分位数直径与临床结局之间的明确关联。然而，DES 与 BMS 独立相关，与所有直径三分位数的 TVR 风险降低相关，与最大直径三分位数（>3.4mm）的非致死性 MI 或死亡风险降低相关（0.66[0.44 至 0.99]）。
独立于不良患者和病变特征，DES 在最长支架长度（>23mm）和最大直径（>3.4mm）内与 BMS 相比，2 年内 TVR 和非致死性 MI 或死亡的风险显著降低。
