Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
JACC Cardiovasc Interv. 2011 Sep;4(9):965-73. doi: 10.1016/j.jcin.2011.06.009.
The purpose of this study was to evaluate the long-term safety and effectiveness of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease.
DES are frequently implanted for SVG interventions, but some studies have shown that they are not effective in reducing target vessel revascularization (TVR) over longer-term follow-up. Some studies suggest there is increased mortality with DES compared with bare-metal stents (BMS).
We performed propensity score matching analysis using a population-based cohort that included 709 well-matched pairs (n = 1,418) who received DES or BMS for the treatment of SVG disease from 2003 to 2008. Outcomes of interest included repeat TVR, myocardial infarction, and death.
The mean age of the propensity-matched cohort was 69 years, 50% had diabetes, and the mean age of SVG was 10.6 years. At 4-year follow-up, the rate of repeat TVR was 21% in the DES group and 27.6% in the BMS group (p = 0.004). DES implantation was associated with the largest TVR reduction among patients with diabetes and patients receiving longer stents (≥30 mm) and the number of procedures needed to prevent a TVR at 4 years was 8 and 7, respectively. The composite rate of myocardial infarction or death was not significantly different between DES and BMS at 4 years (27.8% vs. 32.6%, p = 0.09).
Implantation of DES in the treatment of SVG disease is associated with substantial reduction of repeat revascularization, without evidence of an increased risk of myocardial infarction or death at longer-term follow-up.
本研究旨在评估药物洗脱支架（DES）治疗隐静脉桥（SVG）疾病的长期安全性和有效性。
DES 常用于 SVG 介入治疗，但一些研究表明，在长期随访中，它们并不能有效减少靶血管血运重建（TVR）。一些研究表明，DES 与裸金属支架（BMS）相比，死亡率更高。
我们使用基于人群的队列进行倾向评分匹配分析，该队列包括 709 对匹配良好的患者（n = 1418），他们在 2003 年至 2008 年间接受 DES 或 BMS 治疗 SVG 疾病。感兴趣的结局包括重复 TVR、心肌梗死和死亡。
倾向评分匹配队列的平均年龄为 69 岁，50%患有糖尿病，SVG 的平均年龄为 10.6 年。在 4 年随访时，DES 组的重复 TVR 率为 21%，BMS 组为 27.6%（p = 0.004）。DES 植入与糖尿病患者和接受较长支架（≥30mm）患者的 TVR 减少量最大，4 年内预防 TVR 所需的手术数量分别为 8 和 7。4 年内，DES 和 BMS 之间的心肌梗死或死亡复合率无显著差异（27.8% vs. 32.6%，p = 0.09）。
在治疗 SVG 疾病时，植入 DES 与重复血运重建的大量减少相关，在长期随访中没有证据表明心肌梗死或死亡的风险增加。
