Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Cardiovascular Research Institute, Busan, South Korea.
Int J Cardiol. 2012 Sep 20;160(1):48-52. doi: 10.1016/j.ijcard.2011.03.024. Epub 2011 Aug 6.
Although several randomized trials have shown that sirolimus-eluting stent (SES) substantially reduces in-stent restenosis, recent studies have suggested the possibility of late catch-up after SES implantation. We investigated long-term angiographic outcomes after SES implantation in real-world practice.
This study was conducted on 195 patients with 253 lesions who underwent the first and long-term angiographic follow-up after SES implantation. First follow-up was done at near 6 months after SES implantation. Long-term angiographic follow-up was defined as that performed at least 36 months after index procedure. Angiographies in patients who experienced target lesion revascularization at the time of the first angiographic follow-up were excluded from the current analysis.
Minimal luminal diameter at long-term angiographic follow-up was significantly smaller compared with that at the first follow-up (2.21 ± 0.65 vs. 2.40 ± 0.55, p<0.001). In-stent late lumen loss between the first and long-term follow-up tended to be larger compared with that between SES implantation and the first follow-up (0.19 ± 0.47 vs. 0.15 ± 0.39, p=0.298). There was a trend for increased incidence of coronary artery aneurysm (1.6% and 7.5% at the first and long-term follow-up) and stent fracture (4.3% and 10.3%). Two stent aneurysms and one stent fracture were related with definite very late stent thrombosis.
An "angiographic late catch-up" phenomenon and a trend toward increased incidence of coronary artery aneurysm and stent fracture were found at a median 46.5-month angiographic follow-up compared with a median 6-month follow-up.
虽然几项随机试验表明，西罗莫司洗脱支架（SES）可显著减少支架内再狭窄，但最近的研究表明 SES 植入后可能会出现晚期追赶现象。我们研究了 SES 植入后真实世界实践中的长期血管造影结果。
本研究纳入了 195 例 253 处病变患者，这些患者在 SES 植入后进行了首次和长期血管造影随访。首次随访在 SES 植入后近 6 个月进行。长期血管造影随访定义为指数手术后至少 36 个月进行的随访。在首次血管造影随访时发生靶病变血运重建的患者，其血管造影结果被排除在本分析之外。
与首次随访时相比，长期血管造影随访时的最小管腔直径明显较小（2.21±0.65 vs. 2.40±0.55，p<0.001）。SES 植入后与首次随访相比，支架内晚期管腔丢失在首次和长期随访之间趋于更大（0.19±0.47 vs. 0.15±0.39，p=0.298）。冠状动脉瘤的发生率呈增加趋势（首次和长期随访分别为 1.6%和 7.5%）和支架断裂（首次和长期随访分别为 4.3%和 10.3%）。两个支架瘤和一个支架断裂与明确的极晚期支架血栓形成有关。
与中位 6 个月随访相比，在中位 46.5 个月血管造影随访时发现了“血管造影晚期追赶”现象以及冠状动脉瘤和支架断裂发生率增加的趋势。
