Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.
Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, South Korea.
PLoS One. 2018 Oct 5;13(10):e0205046. doi: 10.1371/journal.pone.0205046. eCollection 2018.
Data concerning the effect of current smoking on solely new-generation drug-eluting stents (DES) are limited. We investigated the impact of current smoking on 2-year clinical outcomes between durable-polymer (DP)-coated DES (zotarolimus-eluting [ZES] and everolimus eluting [EES]) and biodegradable-polymer (BP)-coated biolimus-eluting stent (BES) in acute myocardial infarction (AMI) patients after successful percutaneous coronary intervention (PCI).
Finally, a total of 8357 AMI patients with current smoking underwent successful PCI with new-generation DES (ZES, EES, and BES) were enrolled and divided into three groups as ZES (n = 3199), EES (n = 3987), and BES group (n = 1171). The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death (cardiac death [CD] or non-cardiac death), recurrent AMI (re-MI), any revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], and non-TVR). The secondary endpoint was the incidence of definite or probable stent thrombosis (ST).
The 2-year adjusted hazard ratio (HR) of MACE for ZES vs. EES (1.055; 95% confidence interval [CI], 0.843-1.321; p = 0.638), ZES vs. BES (HR, 0.885; 95% CI, 0.626-1.251; p = 0.488), EES vs. BES (HR, 0.889; 95% CI, 0.633-1.250; p = 0.499), and ZES/EES vs. BES (HR, 0.891; 95% CI, 0.648-1.126; p = 0.480) were similar. The occurrence of ST after adjustment were also comparable. In addition, the 2-year adjusted HR for all-cause death, CD, re-MI, TLR, TVR, and non-TVR were not different.
In this study, DP-DES and BP-DES showed comparable safety and efficacy during 2-year follow-up periods. Therefore, DP-DES or BP-DES are equally acceptable in AMI patients with current smoking undergoing PCI.
目前关于现吸烟对新一代药物洗脱支架（DES）影响的数据有限。我们研究了现吸烟对急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）后 2 年临床结局的影响，这些患者使用的是新型 DES，分别为：持久聚合物（DP）涂层 DES（佐他莫司洗脱 [ZES]和依维莫司洗脱 [EES]）和生物可降解聚合物（BP）涂层生物洗脱支架（BES）。
最终，共纳入 8357 例现吸烟的 AMI 患者，这些患者成功接受了新一代 DES（ZES、EES 和 BES）的 PCI，他们被分为三组：ZES 组（n=3199）、EES 组（n=3987）和 BES 组（n=1171）。主要终点为主要不良心脏事件（MACE）的发生，MACE 定义为全因死亡（心源性死亡 [CD]或非心源性死亡）、再发 AMI（再发 MI）、任何血运重建（靶病变血运重建 [TLR]、靶血管血运重建 [TVR]和非 TVR）。次要终点为明确或可能的支架血栓形成（ST）的发生率。
ZES 与 EES 相比，ZES 与 BES 相比，EES 与 BES 相比，ZES/EES 与 BES 相比，2 年调整后的 MACE 风险比（HR）均无显著差异（ZES 与 EES：1.055；95%置信区间 [CI]，0.843-1.321；p=0.638；ZES 与 BES：HR，0.885；95%CI，0.626-1.251；p=0.488；EES 与 BES：HR，0.889；95%CI，0.633-1.250；p=0.499；ZES/EES 与 BES：HR，0.891；95%CI，0.648-1.126；p=0.480）。调整后 ST 的发生也相似。此外，全因死亡、CD、再发 MI、TLR、TVR 和非 TVR 的 2 年调整 HR 也无差异。
在这项研究中，DP-DES 和 BP-DES 在 2 年随访期间表现出相似的安全性和疗效。因此，在现吸烟的 AMI 患者 PCI 中，DP-DES 或 BP-DES 同样可接受。
