Burzotta Francesco, Trani Carlo, Talarico Giovanni Paolo, Tommasino Antonella, Todaro Daniel, Coluccia Valentina, Pirozzolo Giancarlo, Niccoli Giampaolo, Leone Antonio Maria, Porto Italo, Schiavoni Giovanni, Crea Filippo
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Cardiovasc Revasc Med. 2013 May-Jun;14(3):122-7. doi: 10.1016/j.carrev.2013.01.002. Epub 2013 Feb 27.
Different drug-eluting stents (DES) may have different performance in bifurcation PCI. Thus, we compared the performance of a novel zotarolimus-eluting stent (ZRS) with that obtained using two other DES in bifurcation PCI.
Consecutive patients with bifurcated lesions undergoing DES implantation were treated by a provisional approach with sirolimus-eluting stent (SES) or everolimus-eluting stent (EES) during a former period, and then by ZRS in a second period. The PCI procedural details were prospectively recorded and angiographic results were evaluated by a 3-dimensional quantitative coronary analysis software. Primary procedural end-point was "side-branch (SB) trouble" (occurrence, after MV stenting, of: SB TIMI flow<3 or need of specific wires for SB rewiring, or failure to re-wire/dilate the SB). Primary angiographic end-point was post-PCI minimal-lumen-diameter at SB-ostium. During the study, 225 patients were enrolled and treated by ZRS (n=75), by SES (n=75) or by EES (n=75). Among procedural characteristics, "SB trouble" occurred in 4% of patients treated by ZRS, a figure significantly lower compared to SES (16%, P=0.014) and non-significantly lower compared to EES (11%, P=0.12). At multivariable analysis, DES type, pre-PCI SB flow <3 and bifurcation complexity were the only predictors of "SB trouble". After the procedure, minimal-lumen-diameter at SB ostium was significantly larger with ZRS compared to SES (1.94 vs. 1.64 mm, P=0.008) and similar to that of EES.
ZRS is associated to improved performance and SB angiographic results compared to SES. These results support the hypothesis that DES selection may influence the procedural course and the acute angiographic result of bifurcation PCI.
不同的药物洗脱支架（DES）在分叉病变经皮冠状动脉介入治疗（PCI）中可能具有不同的性能。因此，我们比较了一种新型佐他莫司洗脱支架（ZRS）与其他两种DES在分叉病变PCI中的性能。
连续的分叉病变患者在前期接受药物洗脱支架植入时采用临时方法，使用西罗莫司洗脱支架（SES）或依维莫司洗脱支架（EES），然后在第二阶段使用ZRS。前瞻性记录PCI手术细节，并通过三维定量冠状动脉分析软件评估血管造影结果。主要手术终点是“边支（SB）问题”（在主支血管（MV）支架置入后出现：SB TIMI血流<3或需要特定导丝重新开通SB，或无法重新开通/扩张SB）。主要血管造影终点是PCI术后SB开口处的最小管腔直径。在研究过程中，225例患者纳入研究并接受ZRS治疗（n = 75）、SES治疗（n = 75）或EES治疗（n = 75）。在手术特征方面，接受ZRS治疗的患者中“SB问题”发生率为4%，与SES相比显著降低（16%，P = 0.014），与EES相比降低不显著（11%，P = 0.12）。多变量分析显示，DES类型、PCI术前SB血流<3和分叉病变复杂性是“SB问题”的唯一预测因素。术后，ZRS组SB开口处的最小管腔直径显著大于SES组（1.94 vs. 1.64 mm，P = 0.008），与EES组相似。
与SES相比，ZRS与更好的性能和SB血管造影结果相关。这些结果支持以下假设：DES的选择可能影响分叉病变PCI的手术过程和急性血管造影结果。
