Almalla Mohammad, Pross Verena, Marx Nikolaus, Hoffmann Rainer
Department of Cardiology, Medical Clinic I, University Hospital RWTH Aachen, Aachen, Germany.
Coron Artery Dis. 2012 Nov;23(7):492-6. doi: 10.1097/MCA.0b013e328358a58f.
The efficacy of drug-eluting stents (DES) for the treatment of in-stent restenosis (ISR) after DES implantation is not well defined. This study compared the clinical outcome after the use of everolimus-eluting stents (EES) for the treatment of bare-metal stent (BMS) versus DES restenosis.
Ninety-four patients with 94 ISR were included in this study. Sixty-four patients had BMS-ISR and 30 patients had DES-ISR. Patients were treated by repeat PCI using an EES. The primary endpoint of the study was survival free of target lesion revascularization (TLR) at 12 months or DES-ISR versus BMS-ISR patients. The secondary endpoints were survival free of major adverse cardiac events (MACE) and definite stent thrombosis.
The baseline clinical and angiographic parameters were comparable between the two groups. Treatment of DES-ISR was associated with higher rates of recurrent TLR, myocardial infarction (MI), and MACE at the 12-month follow-up compared with the treatment of BMS-ISR (23.3 versus 1.6%, P=0.002 for TLR; 13.3 versus 0%, P=0.017 for MI; and 30 versus 4.6%, P=0.003 for MACE). There were no differences in mortality and definite stent thrombosis between both groups (P=0.5686 and 0.6927, respectively). Initial stent number (odds ratio=1.13, 95% confidence interval 1.02-1.25; P=0.024) and initial stent type being a DES (odds ratio=8.11, 95% confidence interval 5.99-10.45; P<0.001) were independent predictors of recurrent TLR after the treatment of ISR using an EES.
EES used for the treatment of DES-ISR is associated with higher rates of recurrent revascularization, MI, and MACE compared with EES for the treatment of BMS-ISR.
药物洗脱支架（DES）用于治疗DES植入术后的支架内再狭窄（ISR）的疗效尚不明确。本研究比较了使用依维莫司洗脱支架（EES）治疗裸金属支架（BMS）再狭窄与DES再狭窄后的临床结局。
本研究纳入了94例患有94处ISR的患者。64例患者为BMS-ISR，30例患者为DES-ISR。患者接受了使用EES的重复经皮冠状动脉介入治疗（PCI）。研究的主要终点是12个月时无靶病变血管重建（TLR）生存，以及DES-ISR与BMS-ISR患者之间的比较。次要终点是无主要不良心脏事件（MACE）生存和明确的支架血栓形成。
两组之间的基线临床和血管造影参数具有可比性。与治疗BMS-ISR相比，治疗DES-ISR在12个月随访时复发性TLR、心肌梗死（MI）和MACE发生率更高（TLR：23.3%对1.6%，P = 0.002；MI：13.3%对0%，P = 0.017；MACE：30%对4.6%，P = 0.003）。两组之间的死亡率和明确的支架血栓形成无差异（P分别为0.5686和0.6927）。初始支架数量（比值比 = 1.13，95%置信区间1.02 - 1.25；P = 0.024）和初始支架类型为DES（比值比 = 8.11，95%置信区间5.99 - 10.45；P < 0.001）是使用EES治疗ISR后复发性TLR的独立预测因素。
与使用EES治疗BMS-ISR相比，使用EES治疗DES-ISR与更高的复发性血管重建、MI和MACE发生率相关。
