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TWENTE 试验中第二代药物洗脱支架治疗慢性完全闭塞病变的 3 年临床结果。

Three-year clinical outcome after treatment of chronic total occlusions with second-generation drug-eluting stents in the TWENTE trial.

机构信息

Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands.

出版信息

Catheter Cardiovasc Interv. 2015 Feb 15;85(3):E76-82. doi: 10.1002/ccd.25713. Epub 2014 Nov 1.

Abstract

OBJECTIVE

To compare long-term outcome of patients treated for chronic total occlusion (CTO) lesions versus patients treated for non-CTO lesions only.

BACKGROUND

Percutaneous coronary interventions (PCI) for CTO lesions generally have a higher adverse event risk than PCI for non-CTO lesions. However, long-term outcome data from prospective studies with second-generation drug-eluting stent (DES) use in CTO lesions is scarce.

METHODS

We analyzed in this substudy of the TWENTE trial the data of 674 patients, who had stable angina and were electively treated with second-generation DES (Resolute zotarolimus-eluting or Xience V everolimus-eluting stents). Main outcome parameter was target lesion failure (TLF), a composite of cardiac death, target vessel-related myocardial infarction (MI), or target lesion revascularization (TLR).

RESULTS

Patients with CTO lesions (n = 59, 8.8%) were more often treated for lesions in small vessels (94.9% vs. 63.1%, P < 0.001), long lesions (52.5% vs. 17.7%, P < 0.001) and multiple vessels (42.4% vs. 22.4%, P < 0.001), and were less often males (62.7% vs. 74.6%, P < 0.05) than patients with non-CTO lesions (n = 615, 91.2%). J-CTO scores ≥2 were present in 56% of CTO lesions. Despite significant differences in characteristics of patients, lesions, and interventional procedures, the TLF rate at 3-year follow-up was similar for both groups (13.6% vs. 12.9%, P = 0.89). In addition, a patient-oriented composite endpoint (any death, MI or revascularization) did not differ between groups (18.6% vs. 18.8%, P = 0.97).

CONCLUSION

Patients treated with second-generation DES for CTO lesions showed at 3-year follow-up an incidence of adverse clinical events that was low and similar to patients with non-CTO lesions only.

摘要

目的

比较慢性完全闭塞(CTO)病变患者与仅接受非 CTO 病变治疗患者的长期预后。

背景

与非 CTO 病变相比,经皮冠状动脉介入治疗(PCI)治疗 CTO 病变的不良事件风险通常更高。然而,使用第二代药物洗脱支架(DES)的前瞻性研究中关于 CTO 病变的长期预后数据较为匮乏。

方法

我们对 TWENTE 试验的亚组研究中的 674 例患者的数据进行了分析,这些患者患有稳定型心绞痛,择期接受第二代 DES(Resolute 佐他莫司洗脱或 Xience V 依维莫司洗脱支架)治疗。主要终点参数为靶病变失败(TLF),即包括心源性死亡、靶血管相关心肌梗死(MI)或靶病变血运重建(TLR)的复合终点。

结果

CTO 病变患者(n=59,8.8%)更常接受小血管(94.9% vs. 63.1%,P<0.001)、长病变(52.5% vs. 17.7%,P<0.001)和多支血管病变(42.4% vs. 22.4%,P<0.001)的治疗,且男性比例较低(62.7% vs. 74.6%,P<0.05)。56%的 CTO 病变患者 J-CTO 评分≥2。尽管两组患者的特征、病变和介入治疗操作存在显著差异,但 3 年随访时的 TLF 发生率相似(13.6% vs. 12.9%,P=0.89)。此外,患者导向的复合终点(任何死亡、MI 或血运重建)在两组之间也无差异(18.6% vs. 18.8%,P=0.97)。

结论

在 3 年随访时,接受第二代 DES 治疗的 CTO 病变患者的不良临床事件发生率较低,与仅接受非 CTO 病变治疗的患者相似。

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