Beaumont Hospital Royal Oak, Royal Oak, Michigan.
Oakland University William Beaumont School of Medicine, Rochester, Michigan.
Catheter Cardiovasc Interv. 2019 Mar 1;93(4):E211-E216. doi: 10.1002/ccd.27866. Epub 2018 Oct 2.
The objective of this study was to determine the long-term major adverse cardiac events (MACE) in patients treated with intracoronary brachytherapy (ICBT) for coronary in-stent restenosis (ISR).
ICBT was commonly used to treat coronary ISR prior to the availability of drug-eluting stents (DES). The long-term outcomes of ICBT for ISR remain unknown.
Six hundred and eighty consecutive patients who underwent ICBT treated for ISR between September 1998 and April 2005 were included in the study. Clinical and angiographic data were collected and the long-term MACE were measured for all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR) at 10-year follow-up.
Patients were 63 ± 11 years old (66% male). The majority of patients were treated with a bare metal stent 670/680 (99%) prior to ICBT. Significant baseline clinical findings include high incidence of smokers 479/680 (70%), hyperlipidemia 638/680 (94%), and multivessel disease 526/680 (77%). The majority of target lesions were diffuse 407/680 (60%), and either in the left anterior descending 258/680 (38%) or right coronary artery 215/680 (32%). At 10-year follow-up, the rate of death was 25%, MI was 22.4%, and TVR was 48%.
MACE at 10-year follow-up following ICBT for ISR indicates steady rate of death and MI and declining rate of TVR after 5 years.
本研究旨在确定经冠状动脉内放射治疗（ICBT）治疗冠状动脉支架内再狭窄（ISR）患者的长期主要不良心脏事件（MACE）。
在药物洗脱支架（DES）问世之前，ICBT 常用于治疗冠状动脉 ISR。ICBT 治疗 ISR 的长期结果尚不清楚。
本研究纳入了 1998 年 9 月至 2005 年 4 月期间接受 ICBT 治疗 ISR 的 680 例连续患者。收集了临床和血管造影数据，并在 10 年随访时测量了全因死亡、心肌梗死（MI）和靶血管血运重建（TVR）的长期 MACE。
患者年龄为 63±11 岁（66%为男性）。大多数患者在接受 ICBT 治疗前曾接受过 670/680 个裸金属支架（99%）。显著的基线临床发现包括：吸烟者 479/680（70%）、高脂血症 638/680（94%）和多血管疾病 526/680（77%）的高发病率。大多数靶病变为弥漫性病变 407/680（60%），位于左前降支 258/680（38%）或右冠状动脉 215/680（32%）。在 10 年随访时，死亡率为 25%，MI 为 22.4%，TVR 为 48%。
ISR 经 ICBT 治疗 10 年随访的 MACE 表明，死亡和 MI 的发生率稳定，TVR 的发生率在 5 年后下降。
