Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.
Heart Lung Circ. 2013 Jul;22(7):523-32. doi: 10.1016/j.hlc.2012.12.011. Epub 2013 Feb 28.
Drug-eluting stent (DES) deployment during percutaneous coronary intervention (PCI) has reduced target-vessel revascularisation rates (TVR). The selective use of DES in patients at highest risk of restenosis may allay concerns about universal compliance of dual antiplatelet therapy for one year, and potentially reduce costs. If this strategy achieved acceptably low TVR rates, such an approach could be attractive. Late clinical outcomes were examined in 2115 consecutive patients (mean age 63±12 years, 75% male, 22% diabetics) who underwent PCI in the first three years from October 2003, after commencing the following selective criteria for DES use: left main stenosis; ostial lesions of major epicardial arteries; proximal LAD lesions; lesions≥20mm in length with vessel diameter≤3.0mm; lesions in vessels≤2.5mm; diabetics with vessel(s)≤3.0mm; and in-stent restenosis. Among patients undergoing PCI, 2075 (98%) patients received stents (29%≥1 DES and 71% bare metal stent [BMS]), and among those who received DES, there was a 92% compliance with these criteria. There were no differences in clinical outcomes between the two stent groups except for definite stent thrombosis, which occurred in 2% after DES, and 0.6% after BMS at one year (p=0.002). With BMS, large coronary arteries (≥3.5mm), intermediate (3-3.49mm) and small arteries (<3mm) in diameter had a TVR rate at one year of 3.6%, 7.2% and 8.2% respectively (p=0.005). It is possible to use selective criteria for DES while maintaining low TVR rates. The TVR rate with BMS was low in those with stent diameters≥3.5mm. The higher DES stent thrombosis rate reflects first generation DES use, though whether routine second generation DES use reduces these rates needs confirmation.
经皮冠状动脉介入治疗（PCI）中药物洗脱支架（DES）的应用降低了靶血管血运重建率（TVR）。在有再狭窄高危风险的患者中选择性使用 DES，可能减轻对双联抗血小板治疗 1 年的普遍依从性的担忧，并可能降低成本。如果这种策略实现了可接受的低 TVR 率，那么这种方法可能具有吸引力。在 2003 年 10 月开始使用以下选择性 DES 使用标准后的头 3 年内接受 PCI 的 2115 例连续患者（平均年龄 63±12 岁，75%为男性，22%为糖尿病患者）中检查了晚期临床结局：左主干狭窄；主要心外膜动脉开口病变；近端 LAD 病变；长度≥20mm 且血管直径≤3.0mm 的病变；血管直径≤2.5mm 的病变；血管直径≤3.0mm 的糖尿病患者；以及支架内再狭窄。在接受 PCI 的患者中，2075 例（98%）患者接受了支架（29%≥1 个 DES 和 71%为裸金属支架 [BMS]），而在接受 DES 的患者中，有 92%符合这些标准。两组支架患者的临床结局无差异，除了明确的支架血栓形成，DES 组发生率为 2%，BMS 组发生率为 0.6%，均发生在 1 年时（p=0.002）。对于 BMS，直径≥3.5mm（大冠状动脉）、直径为 3-3.49mm（中等）和直径<3mm（小）的冠状动脉，1 年时的 TVR 率分别为 3.6%、7.2%和 8.2%（p=0.005）。使用选择性 DES 标准的同时保持低 TVR 率是可行的。BMS 组中支架直径≥3.5mm 的患者 TVR 率较低。DES 支架血栓形成率较高反映了第一代 DES 的使用，尽管常规第二代 DES 是否可以降低这些比率需要进一步证实。
