Cortese Bernardo, di Palma Gaetano, Cerrato Enrico, Latini Roberto A, Elwany Mostafa, Orrego Pedro S, Seregni Romano G
Unità Operativa di Cardiologia, ASST Fatebenefratelli-Sacco, Milano, Italy.
Fondazione Monasterio-Regione Toscana-Centro Nazionale delle Ricerche, Pisa and Massa, Italy.
J Interv Cardiol. 2017 Oct;30(5):427-432. doi: 10.1111/joic.12415. Epub 2017 Aug 29.
With this prospective study we aim at investigating the long-term outcome of a consecutive cohort of patients successfully treated with bioresorbable scaffold (BVS) implantation.
It is not clearly understood if there is a relation between the technique of BVS implantation and the outcome.
Between December 2012 and December 2014, all consecutive patients treated with BVS were included in this registry and received an angiographic follow-up. After a run-in phase, all BVS were implanted using a specific technique consisting of aggressive predilation, correct scaffold sizing, visually determined, and high-pressure post-dilation with a noncompliance balloon. Primary endpoint was late lumen loss (LLL) at 1-year angiographic follow-up and ischemia-driven target-lesion revascularization (ID-TLR) at 2-year clinical follow-up. Secondary endpoints were the occurrence of binary restenosis, major adverse cardiac events (MACE), and every single component of MACE (cardiac death, myocardial infarction, TLR) at 2 years.
A total of 144 lesions in 122 patients treated consecutively with BVS, were enrolled. Diabetics were 29.5% and acute coronary syndrome at presentation occurred in 29.5% of patients. At the angiographic follow-up LLL was 0.38 ± 0.9. At 2-year clinical follow-up, ID-TLR occurred in eight patients (5.6%). We observed two cases of scaffold thrombosis (1.38%, one early and one very late). At multivariate statistical analysis, STEMI presentation remained a significant predictor for TLR.
In a complex, all-comers real world population, BVS implantation with a specific, and standardized technique showed to be feasible, with acceptable mid-term angiographic and long-term clinical outcome.
通过这项前瞻性研究,我们旨在调查连续一组成功接受生物可吸收支架(BVS)植入治疗的患者的长期预后。
目前尚不清楚BVS植入技术与预后之间是否存在关联。
2012年12月至2014年12月期间,所有连续接受BVS治疗的患者均纳入本登记研究并接受血管造影随访。在导入期后,所有BVS均采用特定技术植入,该技术包括积极预扩张、根据视觉确定正确的支架尺寸以及使用非顺应性球囊进行高压后扩张。主要终点是1年血管造影随访时的晚期管腔丢失(LLL)和2年临床随访时的缺血驱动的靶病变血运重建(ID-TLR)。次要终点是2年时的二元再狭窄、主要不良心脏事件(MACE)以及MACE的每个单一组成部分(心源性死亡、心肌梗死、TLR)的发生情况。
共有122例连续接受BVS治疗的患者的144个病变被纳入研究。糖尿病患者占29.5%,就诊时急性冠状动脉综合征的发生率为29.5%。在血管造影随访时,LLL为0.38±0.9。在2年临床随访时,8例患者(5.6%)发生了ID-TLR。我们观察到两例支架血栓形成(1.38%,一例早期和一例极晚期)。在多变量统计分析中,STEMI表现仍然是TLR的显著预测因素。
在一个复杂的、所有患者的真实世界人群中,采用特定的标准化技术植入BVS显示是可行的,中期血管造影和长期临床结果均可接受。