San Giovanni di Dio Hospital, Agrigento, Italy.
EMO-GVM Centro Cuore and San Raffaele Hospitals, Milan, Italy.
JACC Cardiovasc Interv. 2017 Mar 27;10(6):560-568. doi: 10.1016/j.jcin.2016.12.013. Epub 2017 Mar 1.
The authors sought to investigate 1-year outcomes in patients treated with bioresorbable everolimus-eluting vascular scaffolds (BVS) for "long coronary lesions."
The present substudy derived from the GHOST-EU registry included 1,722 lesions in 1,468 consecutive patients, enrolled between November 2011 and September 2014 at 11 European centers.
The lesions were divided into 3 groups according to continuous BVS length: 1) shorter than 30 mm; 2) between 30 and 60 mm; and 3) longer than 60 mm. Primary device-oriented endpoint (target lesion failure [TLF]) was defined as a combination of cardiovascular death, target vessel myocardial infarction, or clinically driven target lesion revascularization.
Patients with lesions ≥60 mm had more comorbidities and more complex lesion characteristics, including chronic total occlusions (37%), bifurcation lesions (40.3%), higher Syntax score (16.4 ± 7.8), and higher number of scaffolds implanted per lesion (3.3 ± 0.9 mm). The main target vessel was the left anterior coronary artery in all groups. Median follow-up was 384 (interquartile range: 359 to 459) days. One-year follow-up was completed in 70.3% of patients. TLF at 1 year was significantly higher in group C (group A 4.8%, group B 4.5%, group C 14.3%; overall p = 0.001), whereas there were no significant differences between groups A and B. Finally, a numerically higher (but not statistically significant) number of scaffold thromboses were observed in group C when compared with shorter lesions (group A 2.1%, group B 1.1%, group C 3.8%; overall p = 0.29).
In a real-world setting, treatment of long coronary lesions with BVS ≥60 mm was associated with a higher TLF rate, driven by myocardial infarction and clinically driven target lesion revascularization.
作者旨在研究使用生物可吸收依维莫司洗脱血管支架（BVS）治疗“长冠状动脉病变”的患者 1 年的结果。
本亚组研究源自 GHOST-EU 注册研究，该研究纳入了 2011 年 11 月至 2014 年 9 月 11 个欧洲中心的 1468 例连续患者的 1722 处病变。
根据连续 BVS 长度将病变分为 3 组：1）短于 30mm；2）30-60mm；3）长于 60mm。主要器械导向终点（TLF）定义为心血管死亡、靶血管心肌梗死或临床驱动的靶病变血运重建的组合。
病变≥60mm 的患者合并症更多，病变特征更复杂，包括慢性完全闭塞（37%）、分叉病变（40.3%）、更高的 Syntax 评分（16.4±7.8）和每个病变植入的支架数量更多（3.3±0.9mm）。所有病变均位于前降支。中位随访时间为 384（四分位距：359-459）天。1 年随访完成率为 70.3%。C 组的 1 年 TLF 显著更高（A 组 4.8%，B 组 4.5%，C 组 14.3%；总体 p=0.001），而 A 组和 B 组之间无显著差异。最后，与较短病变相比，C 组观察到更多的支架血栓形成（A 组 2.1%，B 组 1.1%，C 组 3.8%；总体 p=0.29）。
在真实世界环境中，使用 BVS≥60mm 治疗长冠状动脉病变与更高的 TLF 率相关，其主要由心肌梗死和临床驱动的靶病变血运重建驱动。
