Nobori生物可吸收涂层依维莫司洗脱支架植入术后支架断裂的发生率及临床影响

Incidence and clinical impact of stent fracture after the Nobori biolimus-eluting stent implantation.

作者信息

Kuramitsu Shoichi, Iwabuchi Masashi, Yokoi Hiroyoshi, Domei Takenori, Sonoda Shinjo, Hiromasa Takashi, Morinaga Takashi, Kobayashi Yohei, Ohe Kensuke, Goya Kaoru, Yamaji Kyohei, Hyodo Makoto, Soga Yoshimitsu, Kondo Katsuhiro, Shirai Shinichi, Ando Kenji, Sakai Koyu, Nobuyoshi Masakiyo

机构信息

Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

出版信息

J Am Heart Assoc. 2014 Mar 20;3(2):e000703. doi: 10.1161/JAHA.113.000703.

BACKGROUND

Stent fracture (SF) after drug-eluting stent implantation has become an important concern. The aim of this study was to assess the incidence, predictors, and clinical impact of SF after biolimus-eluting stent.

METHODS AND RESULTS

A total of 1026 patients with 1407 lesions undergoing the Nobori biolimus-eluting stent implantation and follow-up angiography within 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by using plain fluoroscopy, intravascular ultrasound, or optical coherence tomography during the follow-up. We assessed the rate of SF and the cumulative incidence of clinically driven target lesion revascularization and definite stent thrombosis within 9 months. SF was observed in 58 (4.1%) of 1407 lesions and 57 (5.5%) of 1026 patients. Lesions with hinge motion (OR 8.90, 95% CI 3.84 to 20.6, P<0.001), tortuosity (OR 4.16, 95% CI 1.75 to 9.88, P=0.001), and overlapping stents (OR 2.41, 95% CI 0.95 to 6.10, P=0.06) were predictors of SF. Cumulative incidence of clinically driven target lesion revascularization within 9 months was numerically higher in the SF group than that in the non-SF group (12.0% versus 1.0%). Cumulative incidence of definite stent thrombosis within 9 months tended to be higher in the SF group than that in the non-SF group (1.7% versus 0.5%).

CONCLUSIONS

SF after biolimus-eluting stent occurs in 4.1% of lesions and appears to be associated with clinically driven target lesion revascularization.

背景

药物洗脱支架植入术后的支架断裂（SF）已成为一个重要问题。本研究的目的是评估生物可吸收涂层雷帕霉素洗脱支架植入术后SF的发生率、预测因素及临床影响。

方法与结果

对1026例患者的1407处病变进行了Nobori生物可吸收涂层雷帕霉素洗脱支架植入，并在首次手术后9个月内进行了随访血管造影分析。随访期间，通过普通荧光透视、血管内超声或光学相干断层扫描评估，SF定义为支架完全或部分分离。我们评估了SF发生率以及9个月内临床驱动的靶病变血运重建和明确的支架内血栓形成的累积发生率。在1407处病变中的58处（4.1%）以及1026例患者中的57例（5.5%）观察到了SF。存在铰链运动的病变（比值比8.90，95%可信区间3.84至20.6，P<0.001）、血管迂曲（比值比4.16，95%可信区间1.75至9.88，P=0.001）以及支架重叠（比值比2.41，95%可信区间0.95至6.10，P=0.06）是SF的预测因素。SF组9个月内临床驱动的靶病变血运重建累积发生率在数值上高于非SF组（12.0%对1.0%）。SF组9个月内明确的支架内血栓形成累积发生率倾向于高于非SF组（1.7%对0.5%）。