Hayes Kevin R, Applegate Robert J, Sacrinty Matthew T, Kutcher Michael A, Gandhi Sanjay K, Santos Renato M, Little William C
Wake Forest University School of Medicine, Section of Cardiology, Winston-Salem, NC 27157-1045, USA.
J Invasive Cardiol. 2010 Jun;22(6):266-70.
We sought to examine the clinical presentations and subsequent clinical outcomes of patients undergoing target lesion revascularization (TLR) after either bare-metal stent (BMS) or drug-eluting stent (DES) placement.
The widely held notion that BMS TLR is benign has recently been challenged. While DES substantially reduce TLR, little is known about the clinical syndromes accompanying DES TLR and the long-term clinical outcomes after TLR.
The clinical syndrome at the time of hospitalization when TLR was performed and subsequent clinical outcomes after TLR were assessed in 1,147 BMS patients and 1,246 DES patients who were followed for 3 years. Patients were considered to have TLR when repeat target lesion PCI was required including those with myocardial infarction (MI) and stent thrombosis.
At 3 years, the overall incidence of TLR was higher after BMS compared to DES 98/1,147 (9.2%) vs. 56/1,246 (4.5%); p < 0.001. The clinical presentations at the time of TLR were not always benign with non-STelevation myocardial infarction (N-STEMI) or STEMI in 25% of BMS vs. 34% DES; p = 0.217. The risk of non-fatal MI or death outcomes over 3 years were significantly worse in those with TLR compared to those without TLR; hazard ratio (HR) 2.65 (2.00-3.52), independent of stent type.
The clinical presentation at the time of TLR is not always a benign clinical event and identifies a subgroup of stent-treated patients at high risk for non-fatal MI or death in the 3 years following the index percutaneous coronary intervention, independent of stent type.
我们试图研究接受裸金属支架（BMS）或药物洗脱支架（DES）置入术后进行靶病变血管重建术（TLR）的患者的临床表现及随后的临床结局。
BMS TLR是良性的这一广泛持有的观念最近受到了挑战。虽然DES可大幅降低TLR，但对于DES TLR伴随的临床综合征以及TLR后的长期临床结局知之甚少。
对1147例BMS患者和1246例DES患者进行了3年的随访，评估了进行TLR时的住院临床综合征以及TLR后的后续临床结局。当需要重复进行靶病变经皮冠状动脉介入治疗（PCI）时，包括发生心肌梗死（MI）和支架血栓形成的患者，被视为进行了TLR。
3年时，BMS术后TLR的总体发生率高于DES，分别为98/1147（9.2%）和56/1246（4.5%）；p<0.001。TLR时的临床表现并不总是良性的，25%的BMS患者和34%的DES患者发生非ST段抬高型心肌梗死（N-STEMI）或ST段抬高型心肌梗死（STEMI）；p=0.217。与未进行TLR的患者相比，进行TLR的患者3年内非致命性MI或死亡结局的风险显著更差；风险比（HR）为2.65（2.00-至3.52），与支架类型无关。
TLR时的临床表现并不总是良性临床事件，并且确定了一组在首次经皮冠状动脉介入治疗后的3年中发生非致命性MI或死亡风险较高的支架治疗患者亚组，与支架类型无关。
