Beijk Marcel A M, Koch Karel T, Tijssen Jan G P, Henriques José P S, Baan Jan, Vis Marije M, Meesterman Martin G, Piek Jan J, de Winter Robbert J
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Coron Artery Dis. 2011 Jan;22(1):32-9. doi: 10.1097/MCA.0b013e328340b824.
In the National Institute for Clinical Excellence (NICE) guidelines, lesions with a reference vessel diameter of less than 3.0 mm or lesions with a length of greater than 15 mm are considered carrying a high risk of restenosis. In contrast, lesions with a reference vessel diameter of at least 3.0 mm or a lesion length of 15 mm or less are considered at low risk of restenosis. We performed a retrospective analysis of consecutive patients undergoing nonurgent percutaneous coronary intervention (PCI) comparing bare metal stent (BMS) with drug-eluting stent (DES) using the NICE guidelines.
Between 2003 and 2007, a total of 3883 patients underwent a nonurgent PCI for a de-novo coronary lesion; 2050 patients were considered to be at low risk and 1833 patients were considered at high risk of restenosis according to the NICE criteria. In the low-risk group, the 1-year composite of cardiac death, myocardial infarction, and target vessel revascularization was 10.5% in the BMS group and 11.1% in the DES group (P=0.85). Target lesion revascularization (TLR) was 5.3% by PCI and 1.6% by coronary artery bypass grafting (CABG) in the BMS group and 4.0 and 3.0% in the DES group (P=0.59 and P=0.24). In the high-risk group, the composite of cardiac death, myocardial infarction, and target vessel revascularization was 12.1 and 11.0% in the BMS and DES groups (P=0.48). TLR was 6.7% by PCI and 1.3% by CABG in the BMS group and 3.9 and 2.8% in the DES group (P=0.01; P=0.02). Definite stent thrombosis (ST) was 0.8% in the BMS-treated patients and 1.7% in the DES-treated patients (P=0.09).
In patients with lesions carrying a low risk of restenosis, no differences were observed between BMS and DES in composite end points, TLR, or ST at 1-year follow-up. In patients with lesions carrying a high risk of restenosis, patients treated with BMS had a significantly higher rate of TLR by PCI, but a significantly lower rate of TLR by CABG compared with patients treated with DES. A nonsignificant lower rate of definite ST was observed in the BMS group compared with the DES group.
在英国国家临床优化研究所（NICE）的指南中，参考血管直径小于3.0毫米的病变或长度大于15毫米的病变被认为具有较高的再狭窄风险。相比之下，参考血管直径至少为3.0毫米或病变长度为15毫米或更短的病变被认为再狭窄风险较低。我们使用NICE指南对连续接受非紧急经皮冠状动脉介入治疗（PCI）的患者进行了回顾性分析，比较了裸金属支架（BMS）和药物洗脱支架（DES）。
2003年至2007年期间，共有3883例患者因新发冠状动脉病变接受了非紧急PCI；根据NICE标准，2050例患者被认为再狭窄风险较低，1833例患者被认为再狭窄风险较高。在低风险组中，BMS组心脏死亡、心肌梗死和靶血管血运重建的1年复合发生率为10.5%，DES组为11.1%（P=0.85）。BMS组通过PCI进行的靶病变血运重建（TLR）为5.3%，通过冠状动脉旁路移植术（CABG）进行的为1.6%，DES组分别为4.0%和3.0%（P=0.59和P=0.24）。在高风险组中，BMS组和DES组心脏死亡、心肌梗死和靶血管血运重建的复合发生率分别为12.1%和11.0%（P=0.48）。BMS组通过PCI进行的TLR为6.7%，通过CABG进行的为1.3%，DES组分别为3.9%和2.8%（P=0.01；P=0.02）。BMS治疗患者的明确支架血栓形成（ST）率为0.8%，DES治疗患者为1.7%（P=0.09）。
在再狭窄风险较低的病变患者中，1年随访时BMS和DES在复合终点、TLR或ST方面未观察到差异。在再狭窄风险较高的病变患者中，与DES治疗的患者相比，BMS治疗的患者通过PCI进行的TLR率显著更高，但通过CABG进行的TLR率显著更低。与DES组相比，BMS组的明确ST率略低，但差异无统计学意义。
