Buja Paolo, Lanzellotti Davide, Isabella Giambattista, Napodano Massimo, Panfili Marco, Favaretto Enrico, Iliceto Sabino, Tarantini Giuseppe
Division of Cardiology, Department of Cardiac Thoracic and Vascular Sciences, University of Padua Medical School, Via Giustiniani 2, 35128, Padua, Italy.
Heart Vessels. 2012 Nov;27(6):553-8. doi: 10.1007/s00380-011-0194-5. Epub 2011 Oct 12.
The treatment of elderly patients with coronary artery disease (CAD) is challenging because this population is complex and greatly expanding. Drug-eluting stents (DES) generally improve the outcome in high-risk cases. We evaluated the clinical impact of different first-generation DES, i.e., sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES), in this context. A prospective, nonrandomized, single-center, allcomers registry consecutively enrolling all patients aged ≥75 years eligible for percutaneous coronary intervention (PCI) with DES was carried out. Only one type of DES was implanted per protocol for each patient. Two groups were identified according to the type of implanted stent, i.e., SES and PES. The primary end point encompassed major adverse cardiac events (MACE), including death, myocardial infarction, and target lesion revascularization (TLR). The secondary end point encompassed the rate of definite/probable stent thrombosis and target vessel revascularization (TVR). From June 2004 to May 2008, 151 patients were enrolled. Among them, 112 (74.2%) received SES and 39 (25.8%) received PES. Baseline clinical characteristics were similar, while few angiographic features (ostial location, stent diameter, proximal reference vessel diameter) showed minor differences. At the median follow-up of 22.6 months, primary and secondary end points did not significantly differ in terms of MACE (SES 12.5% vs PES 20.5%, P = 0.3), death (SES 5.4% vs PES 7.7%, P = 0.7), myocardial infarction (SES 4.5% vs PES 10.3%, P = 0.2), TLR (SES 2.7% vs PES 2.6%, P = 1.0), stent thrombosis (SES 1.8% vs PES 5.1%, P = 0.3), and TVR (SES 1.8% vs PES 0%, P = 0.6). In this real-world population of elderly patients treated by DES-PCI for CAD, the overall efficacy and safety have been excellent in both DES, and the choice between SES and PES did not influence the clinical outcome.
老年冠心病（CAD）患者的治疗具有挑战性，因为这一群体情况复杂且规模在不断扩大。药物洗脱支架（DES）通常能改善高危病例的治疗效果。在此背景下，我们评估了不同第一代DES，即西罗莫司洗脱支架（SES）和紫杉醇洗脱支架（PES）的临床影响。开展了一项前瞻性、非随机、单中心、纳入所有患者的注册研究，连续纳入所有年龄≥75岁且符合使用DES进行经皮冠状动脉介入治疗（PCI）条件的患者。按照方案，每位患者仅植入一种类型的DES。根据植入支架的类型确定了两组，即SES组和PES组。主要终点包括主要不良心脏事件（MACE），包括死亡、心肌梗死和靶病变血管重建（TLR）。次要终点包括明确/可能的支架血栓形成率和靶血管重建（TVR）。2004年6月至2008年5月，共纳入151例患者。其中，112例（74.2%）接受了SES，39例（25.8%）接受了PES。基线临床特征相似，而少数血管造影特征（开口位置、支架直径、近端参考血管直径）存在细微差异。在22.6个月的中位随访期，主要和次要终点在MACE方面无显著差异（SES为12.5%，PES为20.5%，P = 0.3）、死亡（SES为5.4%，PES为7.7%，P = 0.7）、心肌梗死（SES为4.5%，PES为10.3%，P = 0.2）、TLR（SES为2.7%，PES为2.6%，P = 1.0）、支架血栓形成（SES为1.8%，PES为5.1%，P = 0.3）和TVR（SES为1.8%，PES为0%，P = 0.6）。在这个接受DES-PCI治疗CAD的老年患者真实世界群体中，两种DES的总体疗效和安全性都很好，SES和PES之间的选择不影响临床结局。
