Cheng Richard, Vanichsarn Christopher, Patel Jignesh K, Currier Jesse, Chang David H, Kittleson Michelle M, Makkar Raj, Kobashigawa Jon A, Azarbal Babak
Cedars-Sinai Heart Institute, Los Angeles, California.
Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Catheter Cardiovasc Interv. 2017 Jul;90(1):48-55. doi: 10.1002/ccd.26830. Epub 2016 Nov 10.
Percutaneous coronary intervention (PCI) with bare-metal and first-generation drug-eluting stents (DES) for cardiac allograft vasculopathy (CAV) is associated with unexpectedly high restenosis rates and target lesion revascularization (TLR). Long-term outcomes of stenting for CAV using second-generation everolimus-eluting stents (EES) are not established.
To evaluate clinical and angiographic outcomes of CAV stenting with EES.
Patients who underwent PCI with EES for CAV were studied. Surveillance angiography was performed at 6-12 months post-PCI and as indicated. Patient survival, freedom from MACE, binary restenosis, TLR, target vessel revascularization (TVR), and non-TVR are reported.
One-hundred and thirty two EES were placed in 113 discrete lesions in 48 patients. Pre-PCI stenosis was 82.1 ± 12.4%, and average stent length and diameter were 16.9 ± 5.7 and 3.0 ± 0.6 mm, respectively. Mean follow-up was 30.7 ± 18.8 months. Time from transplantation to PCI was 9.9 ± 5.1 years. Post-PCI survival at 1 (93.5 ± 3.6%), 2 (91.0 ± 4.3%), and 3 years (83.8 ± 6.3%), and freedom from MACE (87.2 ± 4.9%, 82.3 ± 5.7%, 75.8 ± 6.9%) were high. Binary restenosis at 1 (3.0 ± 1.7%), 2 (6.9 ± 3.2%), and 3 years (10.0 ± 4.3%) mirrored expected rates with EES use in native CAD. One-, two-, and three-year rates of TLR (5.1 ± 2.5%, 14.3 ± 4.6%, and 21.2 ± 6.3%), TVR (17.1 ± 4.5%, 39.0 ± 6.9%, and 46.2 ± 7.8%), and NTVR (26.3 ± 5.4%, 55.4 ± 7.0%, and 58.0 ± 7.0%) remain high. Diabetes was associated with an increased hazard ratio for binary restenosis 6.084 (95% CI 1.271-29.133, P = 0.024).
PCI strategy using EES in the treatment of CAV was associated with a low binary restenosis rate, a high survival rate, and a high rate of freedom from MACE. However, at 3 years, TLR and TVR rates appeared similar to rates observed with first-generation DES. © 2016 Wiley Periodicals, Inc.
采用裸金属支架和第一代药物洗脱支架（DES）行经皮冠状动脉介入治疗（PCI）以治疗心脏移植血管病变（CAV），其再狭窄率和靶病变血运重建（TLR）出人意料地高。使用第二代依维莫司洗脱支架（EES）治疗CAV的长期疗效尚未确立。
评估采用EES行CAV支架置入术的临床和血管造影结果。
对因CAV接受EES PCI治疗的患者进行研究。在PCI术后6 - 12个月及必要时进行监测血管造影。报告患者生存率、无主要不良心血管事件（MACE）率、二元再狭窄率、TLR、靶血管血运重建（TVR）和非TVR。
在48例患者的113个离散病变处置入了132枚EES。PCI术前狭窄率为82.1±12.4%，平均支架长度和直径分别为16.9±5.7和3.0±0.6mm。平均随访时间为30.7±18.8个月。从移植到PCI的时间为9.9±5.1年。术后1年（93.5±3.6%）、2年（91.0±4.3%）和3年（83.8±6.3%）的生存率以及无MACE率（87.2±4.9%，82.3±5.7%，75.8±6.9%）均较高。1年（3.0±1.7%）、2年（6.9±3.2%）和3年（10.0±4.3%）的二元再狭窄率与在原发性冠状动脉疾病中使用EES时的预期率相似。1年、2年和3年的TLR率（5.1±2.5%，；14.3±4.6%，；21.2±6.3%）、TVR率（17.1±4.5%，；39.0±6.9%，；46.2±7.8%）和非TVR率（26.3±5.4%，；55.4±7.0%，；58.0±7.0%）仍然较高。糖尿病与二元再狭窄的风险比增加相关，为6.084（95%可信区间1.271 - 29.133，P = 0.024）。
采用EES的PCI策略治疗CAV时二元再狭窄率低、生存率高且无MACE率高。然而，3年时，TLR和TVR率似乎与第一代DES观察到的率相似。©2016威利期刊公司。
