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新型无腔隙填充型可降解聚合物西罗莫司洗脱支架治疗初发冠状动脉病变的安全性和有效性:TARGET I 和 TARGET II 试验患者水平汇总分析的 5 年最终结果。

Safety and efficacy of a novel abluminal groove-filled biodegradable polymer sirolimus-eluting stent for the treatment of de novo coronary lesions: Final five-year results of the patient-level pooled analysis from the TARGET I and TARGET II trials.

机构信息

Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China.

Affiliated Ruijin Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Catheter Cardiovasc Interv. 2019 Feb 15;93(S1):818-824. doi: 10.1002/ccd.28051. Epub 2018 Dec 18.

Abstract

OBJECTIVES

The study reports the final 5-year safety and effectiveness outcomes of the novel abluminal groove-filled biodegradable polymer-coated FIREHAWK sirolimus-eluting stent in a large patient cohort.

BACKGROUND

The TARGET clinical program was conducted to evaluate the performance of the FIREHAWK stent, and this objective performance criterion study pooled long-term safety and efficacy data from three TARGET trials for greater statistical power to analyze low-frequency events.

METHODS

Patient-level pooled data from 1,007 individuals in the TARGET I randomized controlled trial (n = 227), TARGET I long lesion cohort (n = 50), and TARGET II registry (n = 730) were prospectively collected and analyzed. The primary endpoint, target lesion failure (TLF), was defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI), and ischemia-driven indicated target lesion revascularization (ID-TLR) at 5 years. All patients were exclusively treated with the FIREHAWK stent and had annual follow-up visits for up to 5 years.

RESULTS

Among 947 patients (94.0%) who completed the 5-year clinical follow-up, the 5-year TLF event rate was 8.1%; the events included 18 cardiac deaths, 36 TV-MIs, and 33 ID-TLRs. Only four (0.4%) very late probable or definite stent thrombosis events were observed beyond 1 year after stent implantation. In the subgroup analysis, lesion length ≥ 30 mm was associated with higher long-term TLF incidence, while the use of a predilation-sizing-postdilation technique showed no significant effect on long-term outcomes.

CONCLUSIONS

Five-year results demonstrate the continuing safety and efficacy of the FIREHAWK Stent, with relatively lower incidence of thrombotic events.

摘要

目的

本研究报告了新型无腔隙填充可生物降解聚合物涂层 FIREHAWK 西罗莫司洗脱支架在大型患者队列中的最终 5 年安全性和有效性结果。

背景

TARGET 临床研究旨在评估 FIREHAWK 支架的性能,本目标性能标准研究汇集了来自三个 TARGET 试验的长期安全性和疗效数据,以获得更大的统计效力来分析低频事件。

方法

TARGET I 随机对照试验(n=227)、TARGET I 长病变队列(n=50)和 TARGET II 注册研究(n=730)中 1007 名患者的患者水平汇总数据前瞻性收集并进行分析。主要终点是靶病变失败(TLF),定义为 5 年内心脏死亡、靶血管心肌梗死(TV-MI)和缺血驱动的靶病变血运重建(ID-TLR)的复合终点。所有患者均仅接受 FIREHAWK 支架治疗,并在 5 年内每年进行随访。

结果

在完成 5 年临床随访的 947 例患者(94.0%)中,5 年 TLF 发生率为 8.1%;事件包括 18 例心脏死亡、36 例 TV-MI 和 33 例 ID-TLR。仅观察到 4 例(0.4%)非常迟发可能或确定的支架血栓形成事件,发生在支架植入后 1 年以上。亚组分析显示,病变长度≥30mm 与长期 TLF 发生率升高相关,而预扩张-测量-后扩张技术的使用对长期结果没有显著影响。

结论

5 年结果表明 FIREHAWK 支架具有持续的安全性和有效性,血栓形成事件发生率相对较低。

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