Ferenc Miroslaw, Buettner Heinz Joachim, Gick Michael, Comberg Thomas, Rothe Juergen, Khoury Firas, Valina Christian, Toma Aurel, Kuebler Piotr, Riede Florian, Neumann Franz-Josef
Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Clin Res Cardiol. 2016 Mar;105(3):230-8. doi: 10.1007/s00392-015-0911-7. Epub 2015 Sep 2.
There is increasing evidence that various types of drug-eluting stents (DES) may differ regarding the long-term safety and efficacy, particularly in complex lesion subsets.
In a cohort of consecutive patients undergoing bifurcation stenting, we sought to compare the 1-year efficacy and safety of the first-generation paclitaxel-eluting stents (PES), the first-generation sirolimus-eluting (SES) and the second-generation everolimus- or zotarolimus-eluting stents (EES/ZES).
We treated 2197 patients (mean age 67.5 years, 75.4 % male) with provisional T-stenting for de novo coronary bifurcation lesions using PES, SES or EES/ZES. Primary endpoint (MACE) was the composite of death from any cause, myocardial infarction (MI) and target lesion revascularisation (TLR).
Side branch stenting was found to be clinically indicated in 793 patients (36.1 %). The cumulative 1-year incidence of MACE was 18.8 % after PES, 13.1 % after PCI with SES and 12.2 % after EES/ZES (p = 0.003), the combined endpoint death and MI occurred in 6.6, 5.6 and 8.3 % (p = 0.253) and death in 4.3, 5.2 and 5.3 % (p = 0.581), respectively. After adjustment for co-variables the type of DES was a significant (p = 0.008) predictor of MACE [HR (95 % confidence interval) PES vs SES 1.34 (1.04-1.71), PES vs. EES/ZES 1.75 (1.19-2.57), EES/ZES vs. SES 0.762 (0.531-1.095)], but not of death (p = 0.581), death and MI (p = 0.077) or stent thrombosis (ST) (p = 0.925).
In de novo coronary bifurcation lesions treated with provisional T-stenting, SES and EES/ZES achieved better outcomes than PES by reducing the need for reintervention.
越来越多的证据表明，各种类型的药物洗脱支架（DES）在长期安全性和有效性方面可能存在差异，特别是在复杂病变亚组中。
在一组接受分叉支架置入术的连续患者中，我们试图比较第一代紫杉醇洗脱支架（PES）、第一代西罗莫司洗脱支架（SES）和第二代依维莫司或佐他莫司洗脱支架（EES/ZES）的1年疗效和安全性。
我们使用PES、SES或EES/ZES对2197例患者（平均年龄67.5岁，男性占75.4%）进行临时T形支架置入术，治疗新发冠状动脉分叉病变。主要终点（MACE）是任何原因导致的死亡、心肌梗死（MI）和靶病变血运重建（TLR）的复合终点。
793例患者（36.1%）临床上需要进行边支支架置入术。PES治疗后1年MACE的累积发生率为18.8%，SES PCI术后为13.1%，EES/ZES术后为12.2%（p = 0.003），死亡和MI的联合终点发生率分别为6.6%、5.6%和8.3%（p = 0.253），死亡率分别为4.3%、5.2%和5.3%（p = 0.581）。在对协变量进行调整后，DES的类型是MACE的显著（p = 0.008）预测因子[风险比（95%置信区间），PES与SES比较为1.34（1.04 - 1.71），PES与EES/ZES比较为1.75（1.19 - 2.57），EES/ZES与SES比较为0.762（0.531 - 1.095）]，但不是死亡（p = 0.581）、死亡和MI（p = 0.077）或支架血栓形成（ST）（p = 0.925）的预测因子。
在采用临时T形支架置入术治疗的新发冠状动脉分叉病变中，SES和EES/ZES通过减少再次干预的需求取得了比PES更好的疗效。
