Karjalainen Pasi P, Niemelä Matti, Laine Mika, Airaksinen Juhani K E, Ylitalo Antti, Nammas Wail
Heart Center, Satakunta Central Hospital, Pori, Finland.
Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland.
Am J Cardiol. 2017 Feb 1;119(3):345-350. doi: 10.1016/j.amjcard.2016.09.057. Epub 2016 Nov 1.
Stent underexpansion is associated with worse outcome after stent implantation. Whether post-dilation (PD) improves outcome in patients with acute coronary syndrome (ACS) remains unclear. We performed post hoc analysis of outcome in patients from the BASE ACS (A prospective randomized comparison of titanium-nitride-oxide-coated bioactive stents with everolimus-eluting stents in acute coronary syndrome) trial who underwent PD versus those who did not. The BASE ACS trial randomized 827 patients (1:1) with ACS to receive either titanium-nitride-oxide-coated bioactive stents or everolimus-eluting stents. The primary end point was major adverse cardiac events (MACE): a composite of cardiac death, nonfatal myocardial infarction (MI), or ischemia-driven target lesion revascularization. Follow-up was planned at 12 months and yearly thereafter for up to 7 years. Of 827 patients enrolled in the BASE ACS trial, 357 (43.2%) underwent PD. Median follow-up duration was 5 years. Patients who underwent PD had less frequent nonfatal MI events at long-term follow-up, compared with those who did not (4.5% vs 8.5%, respectively, p = 0.02). The rates of MACE (15.7% vs 15.1%, respectively, p = 0.81), and the other endpoints, were not significantly different (p >0.5 for all). The results were consistent in propensity score-matched analysis (270 pairs). In patients treated with bioactive stents, those who underwent PD had a trend for a fewer nonfatal MI events (p = 0.076). Comparably, in patients treated with everolimus-eluting stents, MACE and all the individual end points were comparable (p >0.5 for all). In conclusion, patients treated with early percutaneous coronary intervention for ACS who underwent PD had less frequent nonfatal MI events at long-term follow-up, compared with those who did not; MACE rates were not significantly different.
支架扩张不足与支架植入术后较差的预后相关。后扩张（PD）能否改善急性冠状动脉综合征（ACS）患者的预后仍不明确。我们对来自BASE ACS试验（一项急性冠状动脉综合征中氮化钛氧化物涂层生物活性支架与依维莫司洗脱支架的前瞻性随机对照试验）中接受PD和未接受PD的患者的预后进行了事后分析。BASE ACS试验将827例ACS患者按1:1随机分组，分别接受氮化钛氧化物涂层生物活性支架或依维莫司洗脱支架。主要终点是主要不良心脏事件（MACE）：包括心源性死亡、非致死性心肌梗死（MI）或缺血驱动的靶病变血运重建的复合终点。计划随访12个月，此后每年随访一次，最长7年。在BASE ACS试验纳入的827例患者中，357例（43.2%）接受了PD。中位随访时间为5年。与未接受PD的患者相比，接受PD的患者在长期随访中非致死性MI事件的发生频率较低（分别为4.5%和8.5%，p = 0.02）。MACE发生率（分别为15.7%和15.1%，p = 0.81）以及其他终点无显著差异（所有p>0.5）。倾向评分匹配分析（270对）结果一致。在接受生物活性支架治疗的患者中，接受PD的患者非致死性MI事件有减少趋势（p = 0.076）。同样，在接受依维莫司洗脱支架治疗的患者中，MACE和所有个体终点相当（所有p>0.5）。总之，与未接受PD的患者相比，接受早期经皮冠状动脉介入治疗的ACS患者在长期随访中非致死性MI事件的发生频率较低；MACE发生率无显著差异。
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