Gokay Seher, Cicek Davran, Muderrisoglu Haldun
Department of Cardiology, Baskent University School of Medicine, Saray Mah, Yunusemre cad, No: 1, 07400, Antalya, Turkey.
Department of Cardiology, Baskent University School of Medicine, Bahcelievler, No: 1, Ankara, Turkey.
Cardiol Res. 2012 Jun;3(3):116-122. doi: 10.4021/cr170w. Epub 2012 May 20.
Drug-eluting stents have improved the efficacy of percutaneous coronary intervention and made it the preferred therapy in the treatment of ischemic heart diseases including acute coronary syndromes. The objective of the study was to compare the clinical efficacy and safety of sirolimus-eluting stent with that of zotarolimus-eluting stent following percutaneous coronary intervention for acute coronary syndrome patients with C-type left anterior descending stenosis.
A total of 154 acute coronary syndrome patients with C-type lesions in the left anterior descending artery, requiring a stent > 28 mm in length, were randomized into two groups to receive either sirolimus- (n = 74) or zotarolimus-eluting stent (n = 80). The follow-up period after stent implantation was approximately 36 months. The primary endpoint was a major cardiac event (a composite of cardiac death, myocardial infarction, or ischemia-related target vessel revascularization), and the secondary endpoint included these individual end points plus stent thrombosis.
After 3 years follow-up, the rate of the primary end point (major cardiac event: cardiac death, myocardial infarction, ischemia-related target vessel revascularization) was 16% in the sirolimus group (n = 12) versus 11.2% in the zotarolimus group (n = 9) (P = 0.2). Although there were four cases of stent thrombosis with sirolimus-eluting stent and one with zotarolimus-eluting stent (4.0% sirolimus vs. 1.25% zotarolimus; P = 0.2), neither non-Q myocardial infarction (4.0%sirolimus vs. 1.25% zotarolimus; P = 0.2) nor stent thrombosis, differed significantly.
Although zotarolimus-eluting stent implantation showed more favorable results with respect to stent thrombosis and major adverse cardiac event rates compared to sirolimus-eluting stent implantation, statistically, both stent groups have nearly similar clinical safety and efficacy in the treatment of acute coronary syndromes with C-type lesions in the left anterior descending artery disease.
药物洗脱支架提高了经皮冠状动脉介入治疗的疗效，使其成为包括急性冠状动脉综合征在内的缺血性心脏病治疗的首选方法。本研究的目的是比较西罗莫司洗脱支架与佐他莫司洗脱支架在经皮冠状动脉介入治疗C型左前降支狭窄急性冠状动脉综合征患者后的临床疗效和安全性。
总共154例左前降支动脉有C型病变、需要植入长度大于28 mm支架的急性冠状动脉综合征患者被随机分为两组，分别接受西罗莫司洗脱支架（n = 74）或佐他莫司洗脱支架（n = 80）。支架植入后的随访期约为36个月。主要终点是主要心脏事件（心脏死亡、心肌梗死或缺血相关靶血管血运重建的复合终点），次要终点包括这些单独的终点加上支架血栓形成。
经过3年随访，西罗莫司组（n = 12）主要终点（主要心脏事件：心脏死亡、心肌梗死、缺血相关靶血管血运重建）发生率为16%，佐他莫司组（n = 9）为11.2%（P = 0.2）。虽然西罗莫司洗脱支架有4例发生支架血栓形成，佐他莫司洗脱支架有1例（西罗莫司为4.0%，佐他莫司为1.25%；P = 0.2），但非Q波心肌梗死（西罗莫司为4.0%，佐他莫司为1.25%；P = 0.2）和支架血栓形成均无显著差异。
虽然与西罗莫司洗脱支架植入相比，佐他莫司洗脱支架植入在支架血栓形成和主要不良心脏事件发生率方面显示出更有利的结果，但从统计学上看，两组支架在治疗左前降支动脉疾病C型病变的急性冠状动脉综合征方面具有几乎相似的临床安全性和疗效。
