Valencia José, Mainar Vicente, Bordes Pascual, Berenguer Alberto, Ruiz-Nodar Juan Miguel, Pineda Javier, Gomez Silvia, Sogorb Francisco, Caturla Juan
Servicio de Cardiología, Unidad de Cuidados Intensivos, Hospital General Universitario de Alicante, Spain.
Int J Biomed Sci. 2007 Dec;3(4):263-8.
Sirolimus-eluting stents (SES) have demonstrated low incidence of target vessel revascularizations in several anatomic scenarios, including proximal left anterior descending coronary artery (pLAD) lesions. The aim of present study was to compare the efficacy of SES with bare metal stents (BMS) for the treatment of such lesions. 96 patients with severe pLAD stenosis treated with SES were included. Clinical follow-up were performed during a 24 month period. A 98 patient sample with pLAD lesions treated with BMS was taken as control group. Death, angiographic restenosis, new target lesion revascularization (TLR) and target vessel failure (TVF) were registered. Clinical, angiographic and procedural variables were analysed to identify predictors of TVF and TLR. Angiographic procedural success was 100% in SES group vs 99% in BMS group (p=1.0). At 2.5 years, the cumulative rate of TVF was 9.4% in SES group vs 16.3% in BMS group (p=0.15), and the rate of TLR was 5.2% in SES group vs 12.2% in control group (p=0.08). The probabilities of cumulative TVF and TLR free survival were in BMS group 83.7% and 87.8%, and in SES group 90.6% and 94.8%, respectively. After multivariate analysis only SES utilization was found as independent protective factor against TVF and TLR (HR 0.38, 95%CI [0.15-0.94] p=0.037 and HR 0.21, 95%CI [0.06-0.66] p=0.008, respectively), and diabetes as independent predictor of TFV and TLR (HR 2.37, 95%CI [1.07-5.24] p=0.034 and HR 3.57, 95%CI [1.29-9.87] p=0.014, respectively). This study demonstrates that SES utilization is safe and effective in the tretament of pLAD lesions with a better clinical outcome than BMS in a long-term follow-up.
西罗莫司洗脱支架（SES）在包括左冠状动脉前降支近端（pLAD）病变在内的多种解剖情况下，已显示出靶血管再血管化发生率较低。本研究的目的是比较SES与裸金属支架（BMS）治疗此类病变的疗效。纳入了96例接受SES治疗的严重pLAD狭窄患者。在24个月期间进行了临床随访。选取98例接受BMS治疗的pLAD病变患者作为对照组。记录死亡、血管造影再狭窄、新的靶病变再血管化（TLR）和靶血管失败（TVF）情况。分析临床、血管造影和手术变量，以确定TVF和TLR的预测因素。SES组血管造影手术成功率为100%，BMS组为99%（p = 1.0）。在2.5年时，SES组TVF累积发生率为9.4%，BMS组为16.3%（p = 0.15），SES组TLR发生率为5.2%，对照组为12.2%（p = 0.08）。BMS组无TVF和无TLR累积生存率的概率分别为83.7%和87.8%，SES组分别为90.6%和94.8%。多因素分析后发现，仅使用SES是预防TVF和TLR的独立保护因素（HR 0.38，95%CI [0.15 - 0.94]，p = 0.037；HR 0.21，95%CI [0.06 - 0.66]，p = 0.008），而糖尿病是TVF和TLR的独立预测因素（HR 2.37，95%CI [1.07 - 5.24]，p = 0.034；HR 3.57，95%CI [1.29 - 9.87]，p = 0.014）。本研究表明，在长期随访中，使用SES治疗pLAD病变是安全有效的，临床结果优于BMS。
