无保护左主干病变和高解剖学冠脉复杂性患者应用依维莫司洗脱支架后的造影和临床结局。
Angiographic and Clinical Outcomes After Everolimus-Eluting Stenting for Unprotected Left Main Disease and High Anatomic Coronary Complexity.
机构信息
Division of Cardiology, Careggi Hospital, Florence, Italy.
Division of Cardiology, Careggi Hospital, Florence, Italy.
出版信息
JACC Cardiovasc Interv. 2016 May 23;9(10):1001-7. doi: 10.1016/j.jcin.2016.02.016.
OBJECTIVES
This study determined angiographic and clinical outcomes after everolimus-eluting stent (EES)-supported percutaneous coronary intervention for unprotected left main disease (ULMD) and high SYNTAX (SYNergy between PCI with TAXus and Cardiac Surgery) trial score (≥33).
BACKGROUND
The SYNTAX trial has shown the superiority of coronary surgery over percutaneous coronary intervention (PCI) in patients with ULMD and complex coronary anatomy. It has been hypothesized that, if newer generation drug-eluting stents had been used in the SYNTAX trial, there would have been a significant reduction in clinical events.
METHODS
Patients had angiograms scored according to the SYNTAX score algorithm and were divided into 2 groups: those with SYNTAX score of ≥33 and those with <33. The main endpoints were ULMD restenosis and 3-year cardiac mortality.
RESULTS
From May 2008 to July 2014, 393 patients underwent EES implantation for ULMD (181 patients had a SYNTAX score ≥33, whereas 212 patients had a SYNTAX score <33). Overall, the restenosis rate was 4.9% (6% in SYNTAX patients scoring ≥33 and 4.1% in SYNTAX patients scoring <33; p = 0.399). On multivariate analysis, the only variable related to restenosis was stent length (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.02 to 1.09; p = 0.002). Three-year cardiac survival rates were 99 ± 1% and 98 ± 2% in patients with European system for cardiac operative risk evaluation (EuroSCORE) <6 and SYNTAX <33 and ≥33, respectively, and 90 ± 3% and 87 ± 3% in patients with a EuroSCORE >6 and SYNTAX score <33 and ≥33, respectively. EuroSCORE was strongly related to cardiac mortality, while the SYNTAX score ≥33 was not both in patients with a EuroSCORE <6 or ≥6, and there were no interactions between EuroSCORE and SYNTAX score ≥33.
CONCLUSIONS
For ULMD patients, high anatomical complexity as defined by a SYNTAX score ≥33 is not predictive of clinical outcome after PCI. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
目的
本研究旨在探讨经皮冠状动脉介入治疗（PCI）中应用依维莫司洗脱支架（EES）治疗无保护左主干病变（ULMD）和高 SYNTAX 评分（SYNergy between PCI with TAXus and Cardiac Surgery）[SYNTAX 试验]患者的血管造影和临床结局。
背景
SYNTAX 试验表明，对于 ULMD 和复杂冠状动脉解剖结构的患者，冠状动脉旁路移植术（CABG）优于 PCI。有假设认为，如果在 SYNTAX 试验中使用新一代药物洗脱支架，临床事件会显著减少。
方法
根据 SYNTAX 评分算法对患者进行血管造影评分，并将其分为两组：SYNTAX 评分≥33 分组和<33 分组。主要终点为 ULMD 再狭窄和 3 年心脏死亡率。
结果
2008 年 5 月至 2014 年 7 月，393 例患者接受 EES 植入治疗 ULMD，其中 181 例患者 SYNTAX 评分≥33，212 例患者 SYNTAX 评分<33。总的来说，再狭窄率为 4.9%（SYNTAX 评分≥33 的患者为 6%，SYNTAX 评分<33 的患者为 4.1%；p=0.399）。多因素分析显示，唯一与再狭窄相关的变量是支架长度（比值比[OR]：1.06；95%置信区间[CI]：1.02 至 1.09；p=0.002）。欧洲心脏手术风险评估系统（EuroSCORE）<6 和 SYNTAX<33 的患者 3 年心脏生存率分别为 99±1%和 98±2%，EuroSCORE≥33 和 SYNTAX≥33 的患者分别为 90±3%和 87±3%。EuroSCORE 与心脏死亡率密切相关，而 SYNTAX 评分≥33 在 EuroSCORE<6 或≥6 的患者中均不能预测临床结局，且 EuroSCORE 和 SYNTAX 评分≥33 之间无交互作用。
结论
对于 ULMD 患者，SYNTAX 评分≥33 所定义的高解剖学复杂性并不能预测 PCI 后的临床结局。（TAXUS 药物洗脱支架与冠状动脉旁路移植术治疗狭窄血管[SYNTAX]；NCT00114972）。
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