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新型西罗莫司洗脱支架(带有腔外可生物降解聚合物和超薄钴铬合金支柱)与第一代产品在人体中的随机对照四年临床随访:INSPIRON-I试验

Four-year clinical follow-up of the first-in-man randomized comparison of a novel sirolimus eluting stent with abluminal biodegradable polymer and ultra-thin strut cobalt-chromium alloy: the INSPIRON-I trial.

作者信息

Oliveira Marcos Danillo Peixoto, Ribeiro Expedito E, Campos Carlos M, Ribeiro Henrique B, Faillace Bruno L R, Lopes Augusto C, Esper Rodrigo B, Meirelles George X, Perin Marco A, Abizaid Alexandre, Lemos Pedro A

机构信息

1 Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil ; 2 Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil ; 3 Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA ; 4 Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; 5 Cardiology Department, Hospital do Servidor Publico Estadual, São Paulo, Brazil ; 6 Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.

出版信息

Cardiovasc Diagn Ther. 2015 Aug;5(4):264-70. doi: 10.3978/j.issn.2223-3652.2015.07.05.

Abstract

BACKGROUND

The Inspiron™ sirolimus-eluting stent (SES) is a low-dose, ultra-thin-strut cobalt-chromium stent abluminally coated with biodegradable polymers (BP). Previous results from the INSPIRON-I trial, a first-in-man study, have proven the efficacy of the novel stent in reducing neointimal proliferation. The present report aims at evaluating the long-term clinical outcomes of patients enrolled into the INSPIRON-I trial (Clinical Trials Gov. identifier: NCT01093391).

METHODS

A total of 57 patients (60 lesions) were randomly allocated in a 2:1 ratio to treatment with the Inspiron™ SES vs. its equivalent Cronus™ bare metal stent (BMS, both by Scitech Medical™, Aparecida de Goiânia, Goiás, Brazil), in four tertiary centers. The primary endpoint of the present analysis was the occurrence of major adverse cardiac events (MACE) [death, myocardial infarction (MI), target vessel revascularization (TVR) and/or target lesion revascularization (TLR)] at 4 years.

RESULTS

Baseline clinical and angiographic characteristics of both groups were similar. After 4 years, the primary endpoint occurred in 7.9% vs. 23.5% of patients in Inspiron and control groups respectively (P=0.11). The rate of death/MI was similar between the groups, but there was a significant decrease in the risk of repeat revascularization in the Inspiron group compared to the control arm TLR (0.0% vs. 23.5% respectively, P=0.02). There were no stent thromboses in the study population.

CONCLUSIONS

The novel Inspiron™ SES showed a sustained safe and effective clinical profile after 4-year of follow-up, with very low adverse events and null stent thrombosis (ST) occurrence.

摘要

背景

英思派龙™西罗莫司洗脱支架(SES)是一种低剂量、超薄支撑的钴铬合金支架,其管腔外表面涂覆有可生物降解聚合物(BP)。英思派龙-I试验(一项人体首次研究)的先前结果已证实这种新型支架在减少新生内膜增生方面的疗效。本报告旨在评估纳入英思派龙-I试验(临床试验注册号:NCT01093391)患者的长期临床结局。

方法

在四个三级中心,共57例患者(60处病变)按2:1的比例随机分配,分别接受英思派龙™ SES治疗及其等效的克洛诺斯™裸金属支架(BMS,均由巴西戈亚斯州阿帕雷西达戈亚尼亚市的SciTech Medical™公司生产)治疗。本分析的主要终点是4年时主要不良心脏事件(MACE)[死亡、心肌梗死(MI)、靶血管血运重建(TVR)和/或靶病变血运重建(TLR)]的发生情况。

结果

两组的基线临床和血管造影特征相似。4年后,英思派龙组和对照组患者主要终点事件的发生率分别为7.9%和23.5%(P = 0.11)。两组的死亡/MI发生率相似,但与对照组相比,英思派龙组再次血运重建的风险显著降低(分别为0.0%和23.5%,P = 0.02)。研究人群中未发生支架血栓形成。

结论

新型英思派龙™ SES在随访4年后显示出持续安全有效的临床特征,不良事件发生率极低且无支架血栓形成(ST)发生。

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