Baranauskas Arvydas, Bajoras Vilhelmas, Budrys Povilas, Laucevičius Aleksandras, Davidavičius Giedrius
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Centre of Cardiology and Angiology, Vilnius University Hospital Santariškių Clinics, Vilnius, Lithuania.
Acta Med Litu. 2016;23(1):5-10. doi: 10.6001/actamedica.v23i1.3264.
Despite improvements in drug-eluting stent (DES) technology, treatment strategies for long coronary artery lesions remain a controversial issue. The aim of our study was to evaluate the long-term clinical results after FFR guided PCI on long coronary lesions. A total of 74 consecutive patients with significant (mean FFR 0.61 ± 0.11) coronary artery lesions ≥30 mm in length were included in the prospective study. All patients were treated with FFR guided PCI implanting newer generation Biolimus, Everolimus or Zotarolimus eluting stents. Clinical endpoints - target vessel revascularization (TVR) and major adverse cardiac events (MACE) - were recorded at 1 and 2 years. 100% angiographic procedure success was achieved, the mean post procedural FFR was 0.88 ± 0.06. At 2-year follow-up, 6 (8.1%) patients had ischemia driven TVR, all within the first 12 months. There were no target vessel related acute coronary syndromes and definite stent thromboses in the study group. At 2 years, the total MACE rate was 29.7%. There was a trend towards a higher TVR rate in patients with overlapping DES vs single DES implanted (9.6 vs 4.5%, = 0.6). On regression analysis, the total stent length had no influence on the TVR rate. At 2 years after stenting long coronary lesions with newer generation DES the TVR rate was 8.1%, which is acceptable in the high cardiovascular risk population with diffuse coronary artery disease. The total stent length did not affect the long-term clinical outcomes.
尽管药物洗脱支架（DES）技术有所改进，但长冠状动脉病变的治疗策略仍是一个有争议的问题。我们研究的目的是评估在血流储备分数（FFR）指导下对长冠状动脉病变进行经皮冠状动脉介入治疗（PCI）后的长期临床结果。共有74例连续的冠状动脉病变长度≥30 mm且严重（平均FFR 0.61±0.11）的患者纳入了这项前瞻性研究。所有患者均接受了FFR指导的PCI治疗，植入了新一代生物雷帕霉素、依维莫司或佐他莫司洗脱支架。在1年和2年时记录临床终点——靶血管血运重建（TVR）和主要不良心脏事件（MACE）。血管造影手术成功率达到100%，术后平均FFR为0.88±0.06。在2年随访时，6例（8.1%）患者出现缺血驱动的TVR，均在最初12个月内。研究组中没有与靶血管相关的急性冠状动脉综合征和明确的支架血栓形成。在2年时，总的MACE发生率为29.7%。植入重叠DES的患者与植入单枚DES的患者相比，TVR发生率有升高趋势（9.6%对4.5%，P = 0.6）。回归分析显示，支架总长度对TVR发生率没有影响。在用新一代DES对长冠状动脉病变进行支架置入术后2年，TVR发生率为8.1%，这在患有弥漫性冠状动脉疾病的高心血管风险人群中是可以接受的。支架总长度不影响长期临床结果。
