Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Am J Cardiol. 2013 Oct 15;112(8):1093-8. doi: 10.1016/j.amjcard.2013.05.054. Epub 2013 Jul 2.
The safety and efficacy outcomes of stent overlap with second-generation drug-eluting stents (DES) have not been well established. This study aimed to compare the 1-year clinical outcomes of overlapping everolimus-eluting stents (EES) with those of overlapping first-generation DES. This retrospective analysis included 350 patients treated with overlapping EES (169 patients with 237 lesions), sirolimus-eluting stents (SES, 102 patients with 252 lesions), or paclitaxel-eluting stents (PES, 79 patients with 182 lesions). End points were major adverse cardiovascular events (MACE: defined as the composite of death, myocardial infarction, or target lesion revascularization), target vessel revascularization, and definite stent thrombosis at 1 year. During a follow-up of 1 year, overall MACE occurred in 6.5% of EES-, 16.8% of SES-, and 10.1% of PES-treated patients (p = 0.026). Myocardial infarction was lowest in the EES group versus SES and PES groups (0 vs 1.0% vs 2.5%, respectively; p = 0.080), and mortality was similar (3.6% vs 9.0% vs 5.1%, p = 0.162). The EES patients showed a trend toward lower rates of 1-year target lesion revascularization (3.1% vs 8.2% vs 6.5%, p = 0.181) and target vessel revascularization (3.7% vs 9.1% vs 11.7%, p = 0.051) compared with the SES- and PES-treated patients. The cumulative incidence of definite stent thrombosis was lowest in the EES group (0 for EES vs 3.9% for SES vs 2.5% for PES, p = 0.014). In conclusion, stent overlap with EES versus first-generation DES was associated with lower rates of MACE and stent thrombosis. Our results suggest that the use of EES when deploying overlapping stents is effective and safe.
支架重叠使用第二代药物洗脱支架（DES）的安全性和疗效尚未得到充分证实。本研究旨在比较重叠使用依维莫司洗脱支架（EES）与第一代 DES 的 1 年临床结果。本回顾性分析纳入 350 例接受重叠 EES（169 例，237 处病变）、西罗莫司洗脱支架（SES，102 例，252 处病变）或紫杉醇洗脱支架（PES，79 例，182 处病变）治疗的患者。终点事件为主要不良心血管事件（MACE：定义为死亡、心肌梗死或靶病变血运重建的复合终点）、靶血管血运重建和 1 年内明确的支架血栓形成。在 1 年的随访期间，EES、SES 和 PES 组的总体 MACE 发生率分别为 6.5%、16.8%和 10.1%（p=0.026）。EES 组心肌梗死发生率最低，分别为 0%、1.0%和 2.5%（p=0.080），死亡率相似（3.6%、9.0%和 5.1%，p=0.162）。EES 组 1 年靶病变血运重建率（3.1%、8.2%和 6.5%，p=0.181）和靶血管血运重建率（3.7%、9.1%和 11.7%，p=0.051）均低于 SES 和 PES 组。EES 组明确支架血栓形成的累积发生率最低（EES 为 0，SES 为 3.9%，PES 为 2.5%，p=0.014）。总之，与第一代 DES 相比，EES 支架重叠使用可降低 MACE 和支架血栓形成的发生率。我们的研究结果表明，在重叠支架中使用 EES 是有效且安全的。
