Galasso Gennaro, Piccolo Raffaele, Cassese Salvatore, Esposito Giovanni, Cirillo Plinio, Leosco Dario, Rapacciuolo Antonio, Sirico Domenico, De Biase Chiara, Niglio Tullio, Piscione Federico
Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Via S. Pansini, 5. 80131. Naples, Italy.
J Invasive Cardiol. 2012 Jun;24(6):251-5.
To evaluate the safety and efficacy of unrestricted Endeavor Resolute zotarolimus-eluting stent (ZES) use. Furthermore, we sought to evaluate clinical outcomes associated with on- and off-label use of Resolute ZES.
The current study was a prospective, single-center registry. The primary endpoint was major adverse cardiac events (MACE), defined as the composite of death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary endpoints were death, MI, TVR, and stent thrombosis (ST).
A total of 370 patients were prospectively enrolled. Off-label Resolute ZES use was performed in 311 patients (84%). At a mean follow-up of 17.3 ± 6 months, MACE occurred in 31 patients (8.5%), death in 15 (4.1%), MI in 10 (2.7%), and TVR in 19 (5.2%). Definite, probable, and possible ST occurred in 9 patients (2.5%). Off-label Resolute ZES implantation, as compared to on-label use, was not associated with an increased risk of MACE (9.4% vs 3.4%; P=.13), death (4.9% vs 0%; P=.14), MI (3.3% vs 0%; P=.38), and TVR (5.5% vs 3.4%; P=.75). On multivariable analysis, previous revascularization (P=.008), but not off-label Resolute ZES implantation (P=.07), was associated with MACE.
In daily clinical practice, Resolute ZES was mostly implanted in patients with off-label indications and associated with a relatively low rate of MACE and TVR.
评估无限制使用安进公司的雷帕霉素洗脱支架(ZES)的安全性和有效性。此外,我们试图评估雷帕霉素洗脱支架(Resolute ZES)的适应证内和适应证外使用相关的临床结果。
本研究为前瞻性单中心注册研究。主要终点为主要不良心脏事件(MACE),定义为死亡、心肌梗死(MI)和靶血管血运重建(TVR)的复合事件。次要终点为死亡、MI、TVR和支架血栓形成(ST)。
共有370例患者前瞻性入组。311例患者(84%)使用了适应证外的雷帕霉素洗脱支架(Resolute ZES)。平均随访17.3±6个月时,31例患者(8.5%)发生MACE,15例患者(4.1%)死亡,10例患者(2.7%)发生MI,19例患者(5.2%)发生TVR。9例患者(2.5%)发生明确、很可能和可能的ST。与适应证内使用相比,适应证外植入雷帕霉素洗脱支架(Resolute ZES)与MACE风险增加无关(9.4%对3.4%;P = 0.13)、死亡风险增加无关(4.9%对0%;P = 0.14)、MI风险增加无关(3.3%对0%;P = 0.38)以及TVR风险增加无关(5.5%对3.4%;P = 0.75)。多变量分析显示,既往血运重建(P = 0.008)而非适应证外植入雷帕霉素洗脱支架(Resolute ZES)(P = 0.07)与MACE相关。
在日常临床实践中,雷帕霉素洗脱支架(Resolute ZES)大多植入有适应证外指征的患者,且MACE和TVR发生率相对较低。