Nishimoto Yuji, Ueda Yasunori, Sugihara Ryuta, Murakami Ayaka, Ueno Keisuke, Takeda Yasuharu, Hirata Akio, Kashiwase Kazunori, Higuchi Yoshiharu, Yasumura Yoshio
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
Cardiovascular Division, Osaka National Hospital, Osaka, Japan.
J Cardiol. 2017 Sep;70(3):297-302. doi: 10.1016/j.jjcc.2016.11.012. Epub 2016 Dec 26.
First-generation drug-eluting stents (DES) have reduced short-term stent failure as compared to bare-metal stents due to the inhibition of neointima hyperplasia, but instead increased the risk of very-late stent failure. Although better outcomes have been reported for second-generation DES than for first-generation DES, the difference in the angioscopic findings at 1-year follow-up has not been adequately elucidated among second-generation DES.
Consecutive 161 patients who received angioscopic examination at 1 year after implantation of second-generation DES, i.e. Nobori biolimus-eluting stents (Terumo, Tokyo, Japan) (N-BES, n=25), Xience everolimus-eluting stents (Abbot Vascular, Santa Clara, CA, USA; X-EES, n=95), or Resolute zotarolimus-eluting stents (Resolute Integrity; Medtronic, Minneapolis, MN, USA; R-ZES, n=41), in de novo native coronary lesions were analyzed.
Maximum neointima coverage grade (N-BES, 0.9±0.3; X-EES, 1.2±0.4; R-ZES, 1.5±0.5; p<0.001) was the highest in R-ZES and lowest in N-BES. Heterogeneity score was higher in R-ZES than in N-BES (N-BES, 0.8±0.4; X-EES, 0.9±0.4; R-ZES, 1.1±0.5; p=0.007). Maximum yellow color grade and prevalence of thrombus were not different. Multivariate analysis demonstrated that only stent type was associated with maximum neointima coverage grade; stent type and total stent length were associated with heterogeneity score; and stenting for acute coronary syndrome (ACS) and total stent length were associated with maximum yellow color grade.
Neointima coverage and heterogeneity were mainly determined by stent type even among second-generation DES, while yellow color was determined mainly by whether target lesion was of ACS.
与裸金属支架相比，第一代药物洗脱支架（DES）由于抑制了内膜增生，降低了短期支架失败率，但却增加了极晚期支架失败的风险。尽管第二代DES的治疗效果优于第一代DES，但第二代DES在1年随访时的血管镜检查结果差异尚未得到充分阐明。
对161例连续接受第二代DES植入后1年血管镜检查的患者进行分析，这些患者的原发冠状动脉病变植入的第二代DES分别为：Nobori生物雷帕霉素洗脱支架（Terumo，东京，日本）（N-BES，n = 25）、Xience依维莫司洗脱支架（Abbot Vascular，圣克拉拉，加利福尼亚州，美国；X-EES，n = 95）或Resolute佐他莫司洗脱支架（Resolute Integrity；美敦力公司，明尼阿波利斯，明尼苏达州，美国；R-ZES，n = 41）。
最大内膜覆盖分级（N-BES，0.9±0.3；X-EES，1.2±0.4；R-ZES，1.5±0.5；p<0.001）在R-ZES中最高，在N-BES中最低。R-ZES的异质性评分高于N-BES（N-BES，0.8±0.4；X-EES，0.9±0.4；R-ZES，1.1±0.5；p = 0.007）。最大黄色分级和血栓发生率无差异。多因素分析表明，仅支架类型与最大内膜覆盖分级相关；支架类型和总支架长度与异质性评分相关；急性冠状动脉综合征（ACS）的支架置入和总支架长度与最大黄色分级相关。
即使在第二代DES中，内膜覆盖和异质性主要由支架类型决定，而黄色主要由靶病变是否为ACS决定。
