Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA.
Am J Cardiol. 2011 Sep 1;108(5):665-8. doi: 10.1016/j.amjcard.2011.04.014. Epub 2011 Jun 20.
Although not a definitive treatment, percutaneous coronary intervention offers a palliative benefit to patients with cardiac allograft vasculopathy. Given the superior outcomes with drug-eluting stents (DESs) over bare metal stents (BMSs) in native coronary artery disease, similar improvements might be expected in transplant patients; however, the results have been mixed. Consecutive cardiac transplantation recipients at a single center receiving a stent for de novo cardiac allograft vasculopathy from 1997 to 2009 were retrospectively analyzed according to receipt of a DES versus a BMS. The angiographic and clinical outcomes were subsequently evaluated at 1 year. The baseline clinical and procedural characteristics were similar among those receiving DESs (n = 18) and BMSs (n = 16). Quantitative coronary angiography revealed no difference in the reference diameter, lesion length, or pre-/postprocedural minimal luminal diameter. At the 12-month angiographic follow-up visit, the mean lumen loss was significantly lower in the DES group than in the BMS group (0.19 ± 0.73 mm vs 0.76 ± 0.97 mm, p = 0.02). The DES group also had a lower rate of in-stent restenosis (12.5% vs 33%, p = 0.18), as well as a significantly lower rate of target lesion revascularization (0% vs 19%, p = 0.03). At 1 year, DESs were associated with a lower composite rate of cardiac death and nonfatal myocardial infarction (12% vs 38%, p = 0.04). In conclusion, DESs are safe and effective in the suppression of neointimal hyperplasia after percutaneous coronary intervention for cardiac allograft vasculopathy, resulting in significantly lower rates of late lumen loss and target lesion revascularization, as well as a reduced combined rate of cardiac death and nonfatal myocardial infarction.
虽然经皮冠状动脉介入治疗不是一种确定性的治疗方法，但它为心脏移植后血管病变患者提供了一种姑息性的益处。鉴于药物洗脱支架 (DES) 在治疗原发性冠状动脉疾病方面优于裸金属支架 (BMS)，因此在移植患者中也可能预期会有类似的改善;然而，结果却喜忧参半。对 1997 年至 2009 年间在单一中心接受支架治疗新发心脏移植后血管病变的连续心脏移植受者进行回顾性分析，根据接受 DES 或 BMS 治疗进行分组。随后在 1 年时评估血管造影和临床结局。接受 DES（n=18）和 BMS（n=16）治疗的患者基线临床和程序特征相似。定量冠状动脉造影显示参考直径、病变长度或术前/术后最小管腔直径无差异。在 12 个月的血管造影随访时，DES 组的平均管腔丢失明显低于 BMS 组（0.19±0.73mm 比 0.76±0.97mm，p=0.02）。DES 组的支架内再狭窄率（12.5%比 33%，p=0.18）以及靶病变血运重建率（0%比 19%，p=0.03）也明显较低。1 年后，DES 组与心脏死亡和非致死性心肌梗死的复合发生率较低（12%比 38%，p=0.04）相关。总之，DES 在抑制心脏移植后血管病变经皮冠状动脉介入治疗后的新生内膜增生方面是安全有效的，导致晚期管腔丢失和靶病变血运重建的发生率显著降低，以及心脏死亡和非致死性心肌梗死的综合发生率降低。
