Chiu Maria, Ko Dennis T, Austin Peter C, Cohen Eric A, Velianou James L, Goeree Ron, Blackhouse Gord, Tu Jack V
Institute for Clinical Evaluative Sciences, Toronto, Canada.
Circ Cardiovasc Qual Outcomes. 2009 Mar;2(2):96-107. doi: 10.1161/CIRCOUTCOMES.108.826057. Epub 2009 Mar 5.
Drug-eluting stents are more effective in reducing restenosis than bare-metal stents. Less certain is the relative performance of 2 widely used drug-eluting stents-sirolimus- and paclitaxel-eluting stents-in diabetic and nondiabetic patients undergoing percutaneous coronary intervention in routine clinical practice. We therefore studied the long-term effectiveness and safety of sirolimus versus paclitaxel stents overall and stratified by the absence or presence of diabetes.
We compared sirolimus and paclitaxel stents in a propensity-score matched cohort of 2054 pairs of patients (835 matched pairs of diabetic patients and 1219 matched pairs of nondiabetic patients) undergoing percutaneous coronary intervention in Ontario between December 1, 2003 and March 31, 2006. The cohort was derived from the Cardiac Care Network of Ontario percutaneous coronary intervention registry and linked to population-based administrative health databases. In the overall cohort, there was no difference in rates of target-vessel revascularization (P=0.47), myocardial infarction (P=0.71), or death (P=0.49). As compared with paclitaxel stents, the use of sirolimus stents was associated with a significantly lower 3-year rate of target-vessel revascularization in nondiabetic patients (8.3% versus 10.0%, P=0.01), but not in diabetic patients (12.7% versus 10.3%, P=0.07). Rates of all-cause mortality were similar in patients receiving sirolimus stents versus paclitaxel stents in both the diabetic (8.4% versus 9.2%, P=0.91) and nondiabetic (4.6% versus 3.0%, P=0.22) groups.
In this large observational study, patients receiving paclitaxel and sirolimus stents had similar mortality rates, but nondiabetic patients receiving sirolimus stents were significantly less likely to require repeat revascularization.
药物洗脱支架在减少再狭窄方面比裸金属支架更有效。在常规临床实践中，接受经皮冠状动脉介入治疗的糖尿病和非糖尿病患者中，两种广泛使用的药物洗脱支架（西罗莫司洗脱支架和紫杉醇洗脱支架）的相对性能尚不确定。因此，我们研究了西罗莫司支架与紫杉醇支架总体上以及按有无糖尿病分层后的长期有效性和安全性。
我们在2054对倾向评分匹配的患者队列（835对匹配的糖尿病患者和1219对匹配的非糖尿病患者）中比较了西罗莫司支架和紫杉醇支架，这些患者于2003年12月1日至2006年3月31日在安大略省接受经皮冠状动脉介入治疗。该队列来自安大略省心脏护理网络经皮冠状动脉介入治疗登记处，并与基于人群的行政健康数据库相链接。在整个队列中，靶血管血运重建率（P = 0.47）、心肌梗死率（P = 0.71）或死亡率（P = 0.49）没有差异。与紫杉醇支架相比，在非糖尿病患者中使用西罗莫司支架与3年靶血管血运重建率显著降低相关（8.3% 对10.0%，P = 0.01），但在糖尿病患者中并非如此（12.7% 对10.3%，P = 0.07）。在糖尿病组（8.4% 对9.2%，P = 0.91）和非糖尿病组（4.6% 对3.0%，P = 0.22）中，接受西罗莫司支架与接受紫杉醇支架的患者全因死亡率相似。
在这项大型观察性研究中，接受紫杉醇和西罗莫司支架的患者死亡率相似，但接受西罗莫司支架的非糖尿病患者需要再次血运重建的可能性显著降低。
