Nakagawa Yoshihisa, Kimura Takeshi, Morimoto Takeshi, Nomura Masanori, Saku Keijiro, Haruta Seiichi, Muramatsu Toshiya, Nobuyoshi Masakiyo, Kadota Kazushige, Fujita Hiroshi, Tatami Ryozo, Shiode Nobuo, Nishikawa Hideo, Shibata Yoshisato, Miyazaki Shunichi, Murata Yoshiharu, Honda Takashi, Kawasaki Tomohiro, Doi Osamu, Hiasa Yoshikazu, Hayashi Yasuhiko, Matsuzaki Masunori, Mitsudo Kazuaki
Division of Cardiology, Tenri Hospital, Tenri, Japan.
Am J Cardiol. 2010 Aug 1;106(3):329-36. doi: 10.1016/j.amjcard.2010.03.031. Epub 2010 Jun 18.
It yet has not been clarified whether there is a late catch-up phenomenon in target lesion revascularization (TLR) after sirolimus-eluting stent (SES) compared to bare metal stent (BMS) implantation. In 12,824 patients enrolled in the j-Cypher Registry, incidences of early (within first year) and late (1 year to 3 years) TLR were compared between 17,050 lesions treated with SESs and 1,259 lesions treated with BMSs. Incidences of TLR in SES-treated lesions were 5.7% at 1 year, 8.1% at 2 years, and 10.0% at 3 years, whereas those in BMS-treated lesions were 14.2%, 15.5%, and 15.5%, respectively (p <0.0001, log-rank test). Incidences of late TLR were significantly higher with SESs compared to BMSs (2.6% vs 1.4% at 2 years and 4.5% vs 1.4% at 3 years, p = 0.0007, log-rank test). A multivariable logistic regression model identified 7 independent risk factors for late TLR at 3 years after SES implantation: hemodialysis, low estimated glomerular filtration rate, ostial right coronary artery, lesion length >or=30 mm, 2 stents for bifurcation, American Heart Association/American College of Cardiology type B2/C, and vessel size <2.5 mm. Of these, 5 factors were common to those for early TLR. In conclusion, a late catch-up phenomenon was observed as indicated by the increasing incidence of late TLR after SES, but not after BMS, implantation. Risk factors for late TLR were generally common to those for early TLR.
与裸金属支架（BMS）植入相比，西罗莫司洗脱支架（SES）植入后靶病变血管重建（TLR）是否存在晚期追赶现象尚未明确。在j-Cypher注册研究纳入的12824例患者中，比较了接受SES治疗的17050处病变和接受BMS治疗的1259处病变的早期（1年内）和晚期（1年至3年）TLR发生率。SES治疗病变的TLR发生率在1年时为5.7%，2年时为8.1%，3年时为10.0%，而BMS治疗病变的TLR发生率分别为14.2%、15.5%和15.5%（p<0.0001，对数秩检验）。与BMS相比，SES的晚期TLR发生率显著更高（2年时为2.6%对1.4%，3年时为4.5%对1.4%，p=0.0007，对数秩检验）。多变量逻辑回归模型确定了SES植入后3年晚期TLR的7个独立危险因素：血液透析、低估计肾小球滤过率、右冠状动脉开口处、病变长度≥30mm、分叉处植入2枚支架、美国心脏协会/美国心脏病学会B2/C型以及血管直径<2.5mm。其中，5个因素与早期TLR的因素相同。总之，SES植入后晚期TLR发生率增加表明存在晚期追赶现象，而BMS植入后未观察到。晚期TLR的危险因素通常与早期TLR的危险因素相同。
