Department of Internal Medicine, Cardiology Division, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Circ Cardiovasc Interv. 2009 Apr;2(2):133-9. doi: 10.1161/CIRCINTERVENTIONS.108.832048. Epub 2009 Apr 1.
Myocardial infarction (MI) after drug-eluting stent placement has been associated with an unfavorable late prognosis. Although the etiology of periprocedural MI is multifactorial, sidebranch occlusion may be an important contributing factor. We sought to identify the incidence of sidebranch occlusion during zotarolimus-eluting stent (ZES) and paclitaxel-eluting stent (PES) placement and to relate sidebranch occlusion to the occurrence of periprocedural MI.
Angiograms were reviewed from patients randomly assigned to treatment with a ZES (597 patients; 943 sidebranches) or a PES (619 patients; 977 sidebranches). Sidebranch occlusion was defined as Thrombolysis in Myocardial Infarction flow grade 0 or 1. Sidebranch occlusion was correlated with frequency of MI, as assessed by the creatine phosphokinase MB isoenzyme. Sidebranch occlusion occurred less often after the first stent deployment in patients treated with ZES (2.2%) than in patients treated with PES (4.0%; P=0.032). A similar reduction in the frequency of sidebranch occlusion at any point during the procedure was found in patients treated with ZES (2.9% versus 4.8% in PES patients; P=0.042). Multivariable predictors of sidebranch occlusion included baseline sidebranch stenosis, complex lesion morphology, smaller baseline minimal lumen diameters, and the use of a PES. Of the 20 patients with MI within 30 days of the procedure, 30% had evidence of sidebranch occlusion during the stent procedure.
Patients treated with ZES were less likely to develop sidebranch occlusion during stent placement than patients treated with PES. Less frequent sidebranch occlusion with ZES may have contributed to the lower frequency rates of periprocedural MI in this study.
药物洗脱支架置入后心肌梗死（MI）与预后不良相关。虽然围手术期 MI 的病因是多因素的，但侧支闭塞可能是一个重要的促成因素。我们旨在确定雷帕霉素洗脱支架（ZES）和紫杉醇洗脱支架（PES）置入过程中侧支闭塞的发生率，并将侧支闭塞与围手术期 MI 的发生联系起来。
对随机接受 ZES（597 例患者；943 个侧支）或 PES（619 例患者；977 个侧支）治疗的患者的血管造影进行了回顾。侧支闭塞定义为心肌梗死溶栓治疗血流分级 0 或 1。侧支闭塞与肌酸磷酸激酶 MB 同工酶评估的 MI 频率相关。与接受 PES 治疗的患者（4.0%；P=0.032）相比，接受 ZES 治疗的患者首次支架置入后侧支闭塞发生率较低（2.2%）。在接受 ZES 治疗的患者中，在手术过程中的任何时间点，侧支闭塞的频率也呈相似降低（ZES 患者为 2.9%，而 PES 患者为 4.8%；P=0.042）。侧支闭塞的多变量预测因素包括基线侧支狭窄、复杂病变形态、更小的基线最小管腔直径和 PES 的使用。在术后 30 天内发生 MI 的 20 例患者中，30%的患者在支架手术过程中存在侧支闭塞的证据。
与接受 PES 治疗的患者相比，接受 ZES 治疗的患者在支架置入期间发生侧支闭塞的可能性较低。在这项研究中，ZES 导致的侧支闭塞发生率较低可能是围手术期 MI 发生率较低的原因之一。
