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评估一种生物工程 CD34 抗体涂层支架(Genous™Stent)的 HEALING IIB 试验的最终结果,该支架旨在通过捕获 CAD 患者循环中的内皮祖细胞来促进血管愈合。

Final results of the HEALING IIB trial to evaluate a bio-engineered CD34 antibody coated stent (Genous™Stent) designed to promote vascular healing by capture of circulating endothelial progenitor cells in CAD patients.

机构信息

Thoraxcenter Rotterdam, Erasmus University Medical Center, Rotterdam, The Netherlands.

出版信息

Atherosclerosis. 2011 Nov;219(1):245-52. doi: 10.1016/j.atherosclerosis.2011.06.032. Epub 2011 Jun 25.

DOI:10.1016/j.atherosclerosis.2011.06.032
PMID:21763653
Abstract

OBJECTIVE

To assess the safety and efficacy of the Genous™ endothelial progenitor cell (EPC) capturing stent in conjunction with HmG-CoA-reductase inhibitors (statins) to stimulate EPC recruitment, in the treatment of patients with de novo coronary artery lesions.

METHODS AND RESULTS

The HEALING IIB study was a multi-center, prospective trial, including 100 patients. The primary efficacy endpoint was late luminal loss by QCA at 6-month follow-up (FU). Although statin therapy increased relative EPC levels by 5.6-fold, the angiographic outcome at 6 month FU was not improved in patients with an overall in-stent late luminal loss of 0.76±0.50 mm. The composite major adverse cardiac events (MACE) rate was 9.4%, whereas 6.3% clinically justified target lesion revascularizations (TLRs) were observed. 2 Patients died within the first 30 days after stent implantation due to angiographically verified in-stent thrombosis. At 12 month FU, MACE and TLR increased to 15.6% and 11.5% respectively and stabilized until 24 month FU. 18 Month angiographic FU showed a significant decrease in late luminal loss (0.67±0.54, 11.8% reduction or 10% by matched serial analysis, P=0.001).

CONCLUSION

The HEALING IIB study suggests that statin therapy in combination with the EPC capture stent does not contribute to a reduction of in-stent restenosis formation for the treatment of de novo coronary artery disease. Although concomitant statin therapy was able to stimulate EPC recruitment, it did not improve the angiographic outcome of the bio-engineered EPC capture stent. Remarkably, angiographic late loss was significantly reduced between 6 and 18 months.

摘要

目的

评估内皮祖细胞(EPC)捕获支架与 HmG-CoA 还原酶抑制剂(他汀类药物)联合应用以刺激 EPC 募集的安全性和有效性,用于治疗新出现的冠状动脉病变患者。

方法和结果

HEALING IIB 研究是一项多中心、前瞻性试验,纳入了 100 例患者。主要疗效终点是 6 个月随访时 QCA 测量的晚期管腔丢失。尽管他汀类药物治疗使相对 EPC 水平增加了 5.6 倍,但在整体支架内晚期管腔丢失为 0.76±0.50mm 的患者中,6 个月 FU 时的血管造影结果并未得到改善。复合主要不良心脏事件(MACE)发生率为 9.4%,而观察到 6.3%的临床合理的靶病变血运重建(TLR)。2 例患者在支架植入后 30 天内死于血管造影证实的支架内血栓形成。在 12 个月 FU 时,MACE 和 TLR 分别增加至 15.6%和 11.5%,并稳定至 24 个月 FU。18 个月的血管造影 FU 显示晚期管腔丢失显著减少(0.67±0.54,减少 11.8%或通过匹配的序列分析减少 10%,P=0.001)。

结论

HEALING IIB 研究表明,他汀类药物治疗联合 EPC 捕获支架并不能减少新出现的冠状动脉疾病的支架内再狭窄形成。虽然同时进行他汀类药物治疗能够刺激 EPC 募集,但并未改善生物工程 EPC 捕获支架的血管造影结果。值得注意的是,6 至 18 个月之间的血管造影晚期管腔丢失显著减少。

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