Tian Wenjie, Mahmoudi Michael, Lhermusier Thibault, Pendyala Lakshmana K, Kiramijyan Sarkis, Saar Minha, Ota Hideaki, Chen Fang, Torguson Rebecca, Suddath William O, Satler Lowell F, Pichard Augusto D, Waksman Ron
Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010, USA.
University of Surrey, Guildford Road, Surrey, GU2-7XH, UK.
Cardiovasc Revasc Med. 2015 Apr-May;16(3):147-50. doi: 10.1016/j.carrev.2015.02.004. Epub 2015 Feb 26.
There is paucity of data regarding the clinical outcome of second generation drug- eluting stents (DES) post rotational atherectomy (RA) for heavily calcified coronary lesions (HCCL).
The study cohort comprised 99 (116 lesions) consecutive patients who underwent RA for HCCL at our institution and received either a first generation DES (40 patients, 53 lesions) or a second generation DES (59 patients, 63 lesions). The analyzed clinical parameters were the 12-month rates of death (all cause and cardiac), Q-wave MI, target lesion revascularization (TLR), definite stent thrombosis (ST) and major adverse cardiac events (MACE) defined as the composite of death, Q-wave MI, or TLR.
The two groups were well matched for their baseline characteristics except for a lower left ventricular ejection fraction in the second generation DES group (46.0±23.0% vs. 55.0±9.0%; p=0.02). The group receiving second generation DES had more type C lesions (81.0% vs. 58.8%; p=0.01), shorter stent length (19.9±6.1 mm vs. 22.7±7.3 mm; p=0.04) and was more likely to undergo stent postdilatation (52.4% vs. 23.1%; p=0.001). The 1-year analyzed clinical parameters were similar in the two groups: all cause death (8.5% vs. 10.3%; p=1.0), cardiac death (8.5% vs. 2.5%; p=0.40), Q-wave MI (0% vs. 0%), TLR (3.6% vs. 2.7%; p=1.0), ST (0% vs. 0%), and MACE (11.9% vs. 12.8%; p=1.0). The 1-year MACE-free survival rate was also similar in the two cohorts.
The use of second generation DES, following RA for HCCL, is associated with similar short and long-term clinical outcomes to first generation DES.
关于第二代药物洗脱支架（DES）用于重度钙化冠状动脉病变（HCCL）旋磨术（RA）后的临床结果，数据较少。
研究队列包括在我们机构接受HCCL旋磨术并接受第一代DES（40例患者，53处病变）或第二代DES（59例患者，63处病变）的99例（116处病变）连续患者。分析的临床参数为12个月的死亡率（全因和心脏原因）、Q波心肌梗死、靶病变血运重建（TLR）、明确的支架血栓形成（ST）以及定义为死亡、Q波心肌梗死或TLR组合的主要不良心脏事件（MACE）。
除第二代DES组左心室射血分数较低外（46.0±23.0%对55.0±9.0%；p=0.02），两组基线特征匹配良好。接受第二代DES的组C型病变更多（81.0%对58.8%；p=0.01），支架长度更短（19.9±6.1mm对22.7±7.3mm；p=0.04），且更可能接受支架后扩张（52.4%对23.1%；p=0.001）。两组1年分析的临床参数相似：全因死亡（8.5%对10.3%；p=1.0）、心脏死亡（8.5%对2.5%；p=0.40）、Q波心肌梗死（0%对0%）、TLR（3.6%对2.7%；p=1.0）、ST（0%对0%）和MACE（11.9%对12.8%；p=1.0）。两个队列的1年无MACE生存率也相似。
HCCL旋磨术后使用第二代DES与第一代DES的短期和长期临床结果相似。
