比较药物洗脱支架和裸金属支架植入治疗冠心病心脏移植受者的长期结果。

Comparison of long-term results of drug-eluting stent and bare metal stent implantation in heart transplant recipients with coronary artery disease.

机构信息

Silesian Centre for Heart Diseases, Slaskie Centrum Chorób Serca, ul. Szpitalna 2, 41-800 Zabrze, Poland.

出版信息

Kardiol Pol. 2010 Feb;68(2):131-4.

PMID:20301021

Abstract

BACKGROUND

Transplanted heart coronary artery disease (TxCAD) may occur in a significant proportion of patients following cardiac transplantation. Drug-eluting stents (DES) have been successfully used in patients with CAD, but their efficacy in TxCAD patients has not been well established.

AIM

To compare long-term results of intracoronary implantation of DES and BMS in patients suffering from TxCAD.

METHODS

We performed a retrospective analysis of all intracoronary stent implantations for TxCAD with at least one control coronary angiography performed during follow-up. We identified 28 DES (all sirolimus-eluting stents, SES) and 28 BMS implantations in 23 patients. The mean follow-up time was 410+/-58 days after DES, and 572+/-434 days after BMS implantation (p=0.004). We compared the occurrence of in-stent restenosis (ISR) in DES and BMS, and survival of patients in the context of risk factors that were identified for each stent implantation separately.

RESULTS

There were 2 (7%) ISR revealed in DES patients (mean time from PCI to restenosis 492+/-58 days) vs. 17 (61%) ISR in BMS patients (mean time from PCI to restenosis 475+/-345 days) (p<0.001). There were 3 (18%) deaths in patients with DES, 4 (31%) in patients with BMS, and 1 (14%) in a patient with DES and BMS (NS). The risk factor profile was comparable, except for higher age at the time of transplantation (46+/-7 vs. 41+/-6 years, p=0.011) and stent implantation (54+/-7 vs. 49+/-6 years, p<0.001) for DES.

CONCLUSION

Favourable long-term results of DES compared with BMS implantation for TxCAD suggest the preferential use of DES in heart transplant recipients.

摘要

背景

心脏移植后，相当一部分患者会出现移植心脏冠状动脉疾病（TxCAD）。药物洗脱支架（DES）已成功应用于 CAD 患者，但它们在 TxCAD 患者中的疗效尚未得到充分证实。

目的

比较 DES 和 BMS 在心包移植后 CAD 患者中的长期疗效。

方法

我们对所有接受心包移植并在随访期间进行至少一次冠状动脉造影的 TxCAD 患者进行了回顾性分析。我们确定了 23 例患者中的 28 例 DES（均为西罗莫司洗脱支架，SES）和 28 例 BMS 植入。DES 植入后的平均随访时间为 410+/-58 天，BMS 植入后的平均随访时间为 572+/-434 天（p=0.004）。我们比较了 DES 和 BMS 支架内再狭窄（ISR）的发生情况，并根据每个支架植入物分别确定的危险因素，比较了患者的生存率。

结果

DES 患者中有 2 例（7%）发生 ISR（PCI 后至再狭窄的平均时间为 492+/-58 天），BMS 患者中有 17 例（61%）发生 ISR（PCI 后至再狭窄的平均时间为 475+/-345 天）（p<0.001）。DES 组有 3 例（18%）死亡，BMS 组有 4 例（31%）死亡，DES 和 BMS 组有 1 例（14%）死亡（NS）。危险因素谱相似，但 DES 组在移植时年龄较高（46+/-7 岁比 41+/-6 岁，p=0.011）和支架植入时年龄较高（54+/-7 岁比 49+/-6 岁，p<0.001）。