Iqbal Javaid, Kwok Chun Shing, Kontopantelis Evangelos, de Belder Mark A, Ludman Peter F, Large Adrian, Butler Rob, Gamal Amr, Kinnaird Tim, Zaman Azfar, Mamas Mamas A
From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.F.L.); Freeman Hospital, Newcastle upon Tyne, United Kingdom (A.G., A.Z.); and Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.).
Circ Cardiovasc Interv. 2017 Apr;10(4). doi: 10.1161/CIRCINTERVENTIONS.116.004457.
There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society).
Patients undergoing percutaneous coronary intervention to SVG in the United Kingdom from January 2006 to December 2013 were divided into 3 groups according to stent use: BMS, first-generation DES, and newer generation DES group. Study outcomes included in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality. Patients (n=15 003) underwent percutaneous coronary intervention to SVG in England and Wales during the study period. Of these, 38% received BMS, 15% received first-generation DES, and 47% received second-generation DES. The rates of in-hospital major adverse cardiovascular events were significantly lower in patients treated with second-generation DES (odds ratio, 0.51; 95% confidence interval, 0.38-0.68; <0.001), but not with first-generation DES, compared with BMS-treated patients. Similarly, 30-day mortality (odds ratio, 0.43; 95% confidence interval, 0.32-0.59; <0.001) and 1-year mortality (odds ratio, 0.60; 95% confidence interval, 0.51-0.71; <0.001) were lower in patients treated with second-generation DES, but not with first-generation DES, compared with the patients treated with BMS.
Patients receiving second-generation DES for the treatment SVG disease have lower rates of in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality, compared with those receiving BMS.
关于当代药物洗脱支架（DES）平台、前代DES和裸金属支架（BMS）用于隐静脉桥（SVG）经皮冠状动脉介入治疗的比较数据有限。我们旨在评估在英国心血管介入学会（BCIS）的一个大型非选择性全国数据集中，接受裸金属支架（BMS）、第一代DES和新一代DES的患者进行SVG经皮冠状动脉介入治疗后的临床结局。
2006年1月至2013年12月在英国接受SVG经皮冠状动脉介入治疗的患者根据支架使用情况分为3组：BMS组、第一代DES组和新一代DES组。研究结局包括院内主要不良心血管事件、30天死亡率和1年死亡率。在研究期间，英格兰和威尔士有15003例患者接受了SVG经皮冠状动脉介入治疗。其中，38%接受BMS，15%接受第一代DES，47%接受第二代DES。与接受BMS治疗的患者相比，接受第二代DES治疗的患者院内主要不良心血管事件发生率显著更低（优势比，0.51；95%置信区间，0.38 - 0.68；<0.001），但第一代DES组无此差异。同样，与接受BMS治疗的患者相比，接受第二代DES治疗的患者30天死亡率（优势比，0.43；95%置信区间，0.32 - 0.59；<0.001）和1年死亡率（优势比，0.60；95%置信区间，0.51 - 0.71；<0.001）更低，但第一代DES组无此差异。
与接受BMS治疗的患者相比，接受第二代DES治疗SVG疾病的患者院内主要不良心血管事件、30天死亡率和1年死亡率更低。
