Wang Xiao-Zeng, Xu Kai, Li Yi, Jing Quan-Min, Liu Hai-Wei, Zhao Xin, Wang Geng, Wang Bin, Ma Ying-Yan, Chen Shao-Liang, Han Ya-Ling
Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, Liaoning 110840, China.
Chin Med J (Engl). 2015 Mar 20;128(6):721-6. doi: 10.4103/0366-6999.152460.
Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations.
From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation.
Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P = 0.045), and MI (5.4% vs. 12.4%, P = 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P = 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21-0.63, P = 0.029) and 0.29 (95% CI: 0.08-0.92, P = 0.037), respectively.
DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
近期研究报告称，对于部分患者，经皮冠状动脉介入治疗并植入支架治疗左主干冠状动脉（LMCA）疾病是安全可行的。然而，在中国人群的长期随访中，与裸金属支架（BMS）相比，药物洗脱支架（DES）在LMCA疾病患者中是否具有更好的预后尚不清楚。
从一项前瞻性多中心注册研究中，1136例因非保护型LMCA狭窄接受BMS或DES植入的连续患者被分为两组：1007例接受DES植入，129例接受BMS植入。主要结局是植入后5年的主要不良心脏事件（MACE）发生率，包括心血管（CV）死亡、心肌梗死（MI）和靶病变血运重建（TLR）。
DES组患者年龄更大，更易患高脂血症和分叉病变。与BMS组患者相比，他们的血管更小，病变更长。在调整后的患者队列中，DES组的5年MACE发生率（19.4%对31.8%，P = 0.022）、CV死亡发生率（7.0%对14.7%，P = 0.045）和MI发生率（5.4%对12.4%，P = 0.049）显著低于BMS组。TLR发生率（10.9%对17.8%，P = 0.110）和支架血栓形成发生率（4.7%对3.9%，P = 0.758）无显著差异。DES组的MACE无事件生存率（80.6%对68.2%，P = 0.023）、CV死亡无事件生存率（93.0%对85.3%，P = 0.045）、TLR无事件生存率（84.5%对72.1%，P = 0.014）和MI无事件生存率（89.9%对80.6%，P = 0.029）显著高于BMS组。当将倾向评分作为协变量纳入Cox模型时，CV死亡风险和MI的调整后风险比分别为0.41（95%置信区间[CI]：0.21 - 0.63，P = 0.029）和0.29（95%CI：0.08 - 0.92，P = 0.037）。
对于LMCA疾病的治疗，DES植入与BMS植入相比具有更有利的临床结局，尽管两组之间的TLR发生率无显著差异。
