佐他莫司与依维莫司洗脱支架治疗真性冠状动脉慢性完全闭塞病变再通后的血管造影及临床结果比较

Zotarolimus compared with everolimus eluting stents-angiographic and clinical results after recanalization of true coronary chronic total occlusions.

作者信息

Markovic Sinisa, Lützner Michael, Rottbauer Wolfgang, Wöhrle Jochen

机构信息

Department of Internal Medicine II, University of Ulm, Germany.

出版信息

Catheter Cardiovasc Interv. 2016 Jul;88(1):18-23. doi: 10.1002/ccd.26482. Epub 2016 Mar 4.

DOI:10.1002/ccd.26482

PMID:26945903

Abstract

OBJECTIVES

To evaluate angiographic and clinical results of ZES compared with EES after recanalization of CTOs.

BACKGROUND

ZES and EES showed similar clinical results in non-CTO lesions. Whether ZES and EES are also comparable in true CTO lesions (TIMI 0 flow, duration of occlusion of more than 3 months) with a higher risk of restenosis has not been addressed so far.

METHODS

125 patients with successful CTO recanalization via antegrade or retrograde approach were included. EES were implanted in 68 patients and ZES in 57 patients. Dual antiplatelet therapy was prescribed for 12 months. Follow-up angiography was scheduled at 9 months and clinical follow-up at 12 months. The primary angiographic outcome measure was in-stent late lumen loss. Primary clinical outcome measures were target lesion revascularization rate (TLR) and major adverse cardiac events (MACE) as a composite of cardiac death, TLR and myocardial infarction not clearly attributable to a non-target vessel.

RESULTS

Baseline characteristics were similar in both groups. Mean stent length was 72.8 ± 33.0mm with EES and 70.8 ± 31.5 mm with ZES (P = 0.72). In-stent late lumen loss was 0.50 ± 0.71 mm for EES compared with 0.59 ± 0.72 (P = 0.52) for ZES. There were similar rates for TLR (EES 10.3% versus ZES 10.5%, P = 0.97) and MACE (EES 10.3% versus ZES 12.3%). No definite or probable stent thrombosis occurred. Stent length but not type of stent was predictive for in-stent late loss and TLR.

CONCLUSION

摘要

目的

评估慢性完全闭塞病变（CTO）再通后，佐他莫司洗脱支架（ZES）与依维莫司洗脱支架（EES）的血管造影结果及临床疗效。

背景

ZES和EES在非CTO病变中显示出相似的临床疗效。ZES和EES在再狭窄风险较高的真性CTO病变（心肌梗死溶栓试验（TIMI）0级血流，闭塞持续时间超过3个月）中是否具有可比性，目前尚未有相关研究。

方法

纳入125例通过顺行或逆行途径成功实现CTO再通的患者。其中68例患者植入EES，57例患者植入ZES。双联抗血小板治疗持续12个月。计划在9个月时进行随访血管造影，在12个月时进行临床随访。主要血管造影结局指标为支架内晚期管腔丢失。主要临床结局指标为靶病变血运重建率（TLR）和主要不良心脏事件（MACE），MACE为心脏死亡、TLR和不能明确归因于非靶血管的心肌梗死的复合事件。

结果

两组患者的基线特征相似。EES组的平均支架长度为72.8±33.0mm，ZES组为70.8±31.5mm（P = 0.72）。EES组的支架内晚期管腔丢失为0.50±0.71mm，ZES组为0.59±0.72mm（P = 0.52）。TLR（EES组为10.3%，ZES组为10.5%，P = 0.97）和MACE（EES组为10.3%，ZES组为12.3%）的发生率相似。未发生明确或可能的支架血栓形成。支架长度而非支架类型可预测支架内晚期丢失和TLR。