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在一家三级医疗中心的连续患者队列中,接受依维莫司洗脱支架与紫杉醇洗脱支架治疗的患者的结局。

Outcomes of Patients Treated with the Everolimus- versus the Paclitaxel-Eluting Stents in a Consecutive Cohort of Patients at a Tertiary Medical Center.

作者信息

Shammas Nicolas W, Shammas Gail A, Nader Elie, Jerin Michael, Mrad Luay, Ehrecke Nicholas, Shammas Waheeb J, Voelliger Cara M, Hafez Alexander, Kelly Ryan, Reynolds Emily

机构信息

Midwest Cardiovascular Research Foundation, Davenport, Iowa.

出版信息

Int J Angiol. 2013 Sep;22(3):165-70. doi: 10.1055/s-0033-1347931.

Abstract

In this study, we compare the outcomes of the paclitaxel-eluting stent (PES) versus the everolimus-eluting stent (EES) treated patients at a tertiary medical center and up to 2 years follow-up. Unselected consecutive patients were retrospectively recruited following stenting with PES (159 patients) or EES (189 patients). The primary endpoint of the study was target lesion failure (TLF), defined as the combined endpoint of cardiac death, nonfatal myocardial infarction (MI), or target lesion revascularization (TLR). Secondary endpoints included target vessel revascularization (TVR), TLR, target vessel failure (TVF), acute stent thrombosis (ST), total death, cardiac death, and nonfatal MI. Patients treated with the PES stent had less congestive heart failure and restenotic lesions, but a higher prevalence of longer lesions, nonleft main bifurcations, required more stents per patient (4.3 ± 2.8 vs. 2.9 ± 2.1). TLF occurred in 32.3% PES versus 21.5% EES (p = 0.027). The secondary unadjusted endpoints for PES versus EES, respectively, were TVF 38.6 versus 30.7% (p = 0.140), TVR 35.7 versus 26.5% (p = 0.079), definite and probable ST 1.2 versus 0.0%, nonfatal MI 4.5 versus 4.2%, and mortality 9.6 versus 4.0%. Logistic regression analysis showed that the numbers of stents per patient (p = 0.001), age (p = 0.01), and renal failure (p = 0.045) were independent predictors of TLF. Using univariate analysis, EES had lower TLF than PES in a cohort of unselected patients undergoing percutaneous coronary intervention at 2 years follow-up. Multivariate analysis showed that the numbers of stents per patient, age, and renal failure, but not stent type, were predictors of TLF.

摘要

在本研究中,我们比较了在一家三级医疗中心接受紫杉醇洗脱支架(PES)和依维莫司洗脱支架(EES)治疗的患者的结局,并进行了长达2年的随访。在使用PES(159例患者)或EES(189例患者)进行支架置入术后,回顾性招募了未经选择的连续患者。该研究的主要终点是靶病变失败(TLF),定义为心源性死亡、非致命性心肌梗死(MI)或靶病变血运重建(TLR)的复合终点。次要终点包括靶血管血运重建(TVR)、TLR、靶血管失败(TVF)、急性支架血栓形成(ST)、全因死亡、心源性死亡和非致命性MI。接受PES支架治疗的患者充血性心力衰竭和再狭窄病变较少,但病变较长、非左主干分叉的患病率较高,每名患者需要更多的支架(4.3±2.8对比2.9±2.1)。PES组TLF发生率为32.3%,EES组为21.5%(p = 0.027)。PES与EES的次要未调整终点分别为TVF 38.6%对比30.7%(p = 0.140)、TVR 35.7%对比26.5%(p = 0.079)、明确和可能的ST 1.2%对比0.0%、非致命性MI 4.5%对比4.2%以及死亡率9.6%对比4.0%。逻辑回归分析显示,每名患者的支架数量(p = 0.001)、年龄(p = 0.01)和肾衰竭(p = 0.045)是TLF的独立预测因素。单因素分析显示,在2年随访的未经选择的接受经皮冠状动脉介入治疗的患者队列中,EES的TLF低于PES。多因素分析显示,每名患者的支架数量、年龄和肾衰竭是TLF的预测因素,而支架类型不是。

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