Yin Dong, Li Jia, Yang Yue-Jin, Wang Yang, Zhao Yan-Yan, You Shi-Jie, Qiao Shu-Bin, Xu Bo, Dou Ke-Fei
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
J Geriatr Cardiol. 2017 Jan;14(1):35-41. doi: 10.11909/j.issn.1671-5411.2017.01.009.
To evaluate the very long-term safety and effectiveness of drug-eluting stents (DES) compared to bare-metal stents (BMS) for patients with large coronary vessels.
From April 2004 to October 2006, 2407 consecutive patients undergoing de novo lesion percutaneous coronary intervention with reference vessel diameter greater than or equal to 3.5 mm at Fu Wai Hospital in Beijing, China, were prospectively enrolled into this study. We obtained 9-year clinical outcomes including death, myocardial infarction (MI), thrombosis, target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of death, MI, and TVR). We performed Cox's proportional-hazards models to assess relative risks of all the outcome measures after propensity match.
After propensity scoring, 514 DES-treated patients were matched to 514 BMS-treated patients. The patients treated with BMS were associated with higher risk of TLR (HR: 2.55, 95%CI: 1.520-4.277, = 0.0004) and TVR (HR: 1.889, 95%CI: 1.185-3.011, = 0.0075), but the rates of death/MI and MACE were not statistically different. All Academic Research Consortium definition stent thrombosis at 9-year were comparable in the two groups.
During long-term follow-up through nine years, use of DES in patients with large coronary arteries was still associated with significant reductions in the risks of TLR and TVR.
评估药物洗脱支架（DES）与裸金属支架（BMS）相比，对大冠状动脉血管患者的长期安全性和有效性。
2004年4月至2006年10月，在中国北京阜外医院，对2407例连续接受首次病变经皮冠状动脉介入治疗且参考血管直径大于或等于3.5mm的患者进行前瞻性研究。我们获得了9年的临床结果，包括死亡、心肌梗死（MI）、血栓形成、靶病变血运重建（TLR）、靶血管血运重建（TVR）以及主要不良心脏事件（MACE，死亡、MI和TVR的复合事件）。我们进行Cox比例风险模型分析，以评估倾向匹配后所有结局指标的相对风险。
经过倾向评分，514例接受DES治疗的患者与514例接受BMS治疗的患者相匹配。接受BMS治疗的患者发生TLR（HR：2.55，95%CI：1.520 - 4.277，P = 0.0004）和TVR（HR：1.889，95%CI：1.185 - 3.011，P = 0.0075）的风险较高，但死亡/MI和MACE的发生率在统计学上无差异。两组9年时所有学术研究联盟定义的支架血栓形成情况相当。
在长达9年的长期随访中，大冠状动脉患者使用DES仍与TLR和TVR风险的显著降低相关。
