Costopoulos Charis, Latib Azeem, Ferrarello Santo, Naganuma Toru, Sticchi Alessandro, Filippo Figini, Giannini Francesco, Basavarajaiah Sandeep, Kawaguchi Masanori, Naim Charbel, Candreva Alessandro, Carlino Mauro, Chieffo Alaide, Montorfano Matteo, Colombo Antonio
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO Centro Cuore Columbus, Milan, Italy; Department of Cardiology, Imperial College University, London, UK.
Cardiovasc Revasc Med. 2013 Nov-Dec;14(6):311-5. doi: 10.1016/j.carrev.2013.09.006. Epub 2013 Oct 21.
Randomized controlled trials have demonstrated that second-generation drug-eluting stents (DESs) for the treatment of obstructive coronary artery disease are associated with comparable, if not improved, clinical outcomes as compared to those of their first-generation counterparts. The aim of this study was to compare the long-term clinical outcomes associated with first- versus second-generation DESs for the treatment of coronary bifurcation lesions.
This was a retrospective study of consecutive de novo bifurcation lesions, excluding those at the left main, treated with either second-generation DES (everolimus-eluting or resolute zotarolimus-eluting stents) between October 2006 and October 2011 (199 bifurcation lesions in 192 patients) or first-generation DES (sirolimus-eluting or paclitaxel-eluting stents) between April 2002 and December 2005 (289 bifurcation lesions in 273 patients).
Second-generation DES use in this setting was associated with less major adverse cardiac events (MACE) (23.1% vs. 14.4%, p=0.02) as well as lower target vessel revascularization (TVR) rates (15.5% vs. 8.3%, p=0.01) at 2-year follow-up. Target lesion revascularization, both per patient (12.6% vs. 7.4%, p=0.02) and per bifurcation (11.8% vs. 7.0%, p=0.03), was also improved with second-generation DES over the same follow-up period. Propensity-score adjusted analysis suggested that second-generation DES was associated with a lower incidence of MACE (HR, 0.53; 95% CI, 0.33-0.85; p=0.01) and TVR (HR, 0.44; 95% CI, 0.24-0.83; p=0.01).
Our results suggest that the use of second-generation DES for the treatment of bifurcation lesions is associated with better clinical outcomes as compared to first-generation DES, largely due to a lower need for repeat revascularization.
随机对照试验表明，用于治疗阻塞性冠状动脉疾病的第二代药物洗脱支架（DES）与第一代同类产品相比，即便没有改善临床结局，至少也具有相当的临床结局。本研究的目的是比较第一代和第二代DES治疗冠状动脉分叉病变的长期临床结局。
这是一项对连续性初发分叉病变进行的回顾性研究，不包括左主干病变，研究对象为2006年10月至2011年10月期间接受第二代DES（依维莫司洗脱或佐他莫司洗脱支架）治疗的患者（192例患者中的199个分叉病变），以及2002年4月至2005年12月期间接受第一代DES（西罗莫司洗脱或紫杉醇洗脱支架）治疗的患者（273例患者中的289个分叉病变）。
在这种情况下，使用第二代DES与2年随访时较少的主要不良心脏事件（MACE）（23.1%对14.4%，p = 0.02）以及较低的靶血管重建率（TVR）（15.5%对8.3%，p = 0.01）相关。在同一随访期内，第二代DES在每位患者（12.6%对7.4%，p = 0.02）和每个分叉病变（11.8%对7.0%，p = 0.03）的靶病变重建方面也有所改善。倾向评分调整分析表明，第二代DES与较低的MACE发生率（HR，0.53；95%CI，0.33 - 0.85；p = 0.01）和TVR发生率（HR，0.44；95%CI，0.24 - 0.83；p = 0.01）相关。
我们的结果表明，与第一代DES相比，使用第二代DES治疗分叉病变与更好的临床结局相关，这主要是因为重复血管重建的需求较低。
