Hoppmann P, Kufner S, Cassese S, Wiebe J, Schneider S, Pinieck S, Scheler L, Bernlochner I, Joner M, Schunkert H, Laugwitz K-L, Kastrati A, Byrne R A
1. med. Klinik, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.
Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636 Munich, Germany.
Catheter Cardiovasc Interv. 2016 Apr;87(5):822-9. doi: 10.1002/ccd.26346. Epub 2015 Dec 28.
We aimed to analyze angiographic and clinical results of patients undergoing BRS implantation in a real-world setting.
Angiographic and clinical outcome data from patients undergoing implantation of drug-eluting bioresorbable stents (BRS) in routine clinical practice is scant.
Consecutive patients undergoing implantation of everolimus-eluting BRS at two high-volume centers in Munich, Germany were enrolled. Data were collected prospectively. All patients were scheduled for angiographic surveillance 6-8 months after stent implantation. Quantitative coronary angiographic analysis was performed in a core laboratory. Clinical follow-up was performed to 12 months and events were adjudicated by independent assessors.
A total of 419 patients were studied. Mean age was 66.6 ± 10.9 years, 31.5% had diabetes mellitus, 76.1% had multivessel disease, and 39.0% presented with acute coronary syndrome; 49.0% of lesions were AHA/ACC type B2/C, 13.1% had treatment of bifurcation lesions. Mean reference vessel diameter was 2.89 ± 0.46 mm. At angiographic follow-up in-stent late loss was 0.26 ± 0.51 mm, in-segment diameter stenosis was 27.5 ± 16.1, and binary angiographic restenosis was 7.5%. At 12 months, the rate of death, myocardial infarction, or target lesion revascularization was 13.1%. Definite stent thrombosis occurred in 2.6%.
The use of everolimus-eluting BRS in routine clinical practice is associated with high antirestenotic efficacy in patients undergoing angiographic surveillance. Overall clinical outcomes at 12 months are satisfactory though stent thrombosis rates are not insignificant. Further study with longer term follow-up and larger numbers of treated patients is required before we can be sure of the role of these devices in clinical practice.
我们旨在分析在真实世界中接受生物可吸收支架(BRS)植入患者的血管造影和临床结果。
在常规临床实践中,关于接受药物洗脱生物可吸收支架(BRS)植入患者的血管造影和临床结局数据较少。
纳入在德国慕尼黑两个大型中心连续接受依维莫司洗脱BRS植入的患者。前瞻性收集数据。所有患者在支架植入后6 - 8个月安排进行血管造影监测。在核心实验室进行定量冠状动脉血管造影分析。临床随访至12个月,事件由独立评估者判定。
共研究了419例患者。平均年龄为66.6±10.9岁,31.5%患有糖尿病,76.1%有多支血管病变,39.0%表现为急性冠状动脉综合征;49.0%的病变为AHA/ACC B2/C型,13.1%接受了分叉病变治疗。平均参考血管直径为2.89±0.46毫米。血管造影随访时,支架内晚期管腔丢失为0.26±0.51毫米,节段直径狭窄为27.5±16.1,二元血管造影再狭窄率为7.5%。在12个月时,死亡、心肌梗死或靶病变血运重建率为13.1%。明确的支架血栓形成发生率为2.6%。
在常规临床实践中使用依维莫司洗脱BRS对接受血管造影监测的患者具有较高的抗再狭窄疗效。尽管支架血栓形成率并非微不足道,但12个月时的总体临床结果令人满意。在我们确定这些装置在临床实践中的作用之前,需要进行更长期随访和更多治疗患者数量的进一步研究。