University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
JACC Cardiovasc Interv. 2012 Jul;5(7):708-17. doi: 10.1016/j.jcin.2012.05.002.
This study sought to evaluate the safety and efficacy of second-generation drug-eluting stents (DES) for patients with unprotected left main coronary artery (ULMCA) stenosis.
The clinical benefit of second-generation DES for ULMCA stenosis has not been determined.
The authors assessed 334 consecutive patients who received everolimus-eluting stents (EES) for ULMCA stenosis between 2009 and 2010. The 18-month incidence rates of major adverse cardiac or cerebrovascular events (MACCE), including death, myocardial infarction (MI), stroke, or ischemia-driven target vessel revascularization (TVR), were compared with those of a randomized study comparing patients who received sirolimus-eluting stents (SES) (n = 327) or coronary artery bypass grafts (CABG) (n = 272).
EES (8.9%) showed a comparable incidence of MACCE as SES (10.8%; adjusted hazard ratio [aHR] of EES: 0.84; 95% confidence interval [CI]: 0.51 to 1.40; p = 0.51) and CABG (6.7%, aHR of EES: 1.40; 95% CI: 0.78 to 2.54; p = 0.26). The composite incidence of death, MI, or stroke also did not differ among patients receiving EES (3.3%), SES (3.7%; aHR of EES: 0.63; 95% CI: 0.27 to 1.47; p = 0.29), and CABG (4.8%; aHR of EES: 0.67; 95% CI: 0.29 to 1.54; p = 0.34). However, the incidence of ischemia-driven TVR in the EES group (6.5%) was higher than in the CABG group (2.6%, aHR of EES: 2.77; 95% CI: 1.17 to 6.58; p = 0.02), but comparable to SES (8.2%, aHR of EES: 1.14; 95% CI: 0.64 to 2.06; p = 0.65). Angiographic restenosis rates were similar in the SES and EES groups (13.8% vs. 9.2%, p = 0.16).
Second-generation EES had a similar 18-month risk of MACCE for ULMCA stenosis as first-generation SES or CABG.
本研究旨在评估第二代药物洗脱支架（DES）治疗无保护左主干冠状动脉（ULMCA）狭窄患者的安全性和疗效。
第二代 DES 治疗 ULMCA 狭窄的临床获益尚未确定。
作者评估了 2009 年至 2010 年间 334 例接受依维莫司洗脱支架（EES）治疗 ULMCA 狭窄的连续患者。比较了 18 个月时主要不良心脑血管事件（MACCE）的发生率，包括死亡、心肌梗死（MI）、卒中和缺血驱动的靶血管血运重建（TVR），并与接受西罗莫司洗脱支架（SES）（n = 327）或冠状动脉旁路移植术（CABG）（n = 272）的随机研究患者进行比较。
EES（8.9%）的 MACCE 发生率与 SES（10.8%；EES 的调整后危险比 [aHR]：0.84；95%置信区间 [CI]：0.51 至 1.40；p = 0.51）和 CABG（6.7%，EES 的 aHR：1.40；95%CI：0.78 至 2.54；p = 0.26）相似。接受 EES（3.3%）、SES（3.7%；EES 的 aHR：0.63；95%CI：0.27 至 1.47；p = 0.29）和 CABG（4.8%；EES 的 aHR：0.67；95%CI：0.29 至 1.54；p = 0.34）的患者复合死亡率、MI 或卒中等的发生率也无差异。然而，EES 组缺血驱动的 TVR 发生率（6.5%）高于 CABG 组（2.6%，EES 的 aHR：2.77；95%CI：1.17 至 6.58；p = 0.02），但与 SES 相似（8.2%，EES 的 aHR：1.14；95%CI：0.64 至 2.06；p = 0.65）。SES 和 EES 组的血管造影再狭窄率相似（13.8%比 9.2%，p = 0.16）。
第二代 EES 治疗 ULMCA 狭窄的 18 个月 MACCE 风险与第一代 SES 或 CABG 相似。
