新一代药物洗脱支架与金属裸支架在静脉桥中的应用-基于倾向评分匹配的 1 年结果（SVG Baltic 注册研究）。
New-generation drug eluting stent vs. bare metal stent in saphenous vein graft - 1 year outcomes by a propensity score ascertainment (SVG Baltic Registry).
机构信息
Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; SIRIO MEDICINE research network, Italy.
First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
出版信息
Int J Cardiol. 2019 Oct 1;292:56-61. doi: 10.1016/j.ijcard.2019.04.022. Epub 2019 Apr 11.
BACKGROUND
Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population.
METHODS AND RESULTS
We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ± 8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50-0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30-0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46-0.96, p = 0.030; and HR 0.53, 95% CI 0.31-0.92, p = 0.020, respectively).
CONCLUSION
In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.
背景
关于经皮冠状动脉介入治疗（PCI）中新型药物洗脱支架（new-DES）与裸金属支架（BMS）治疗静脉桥血管（SVG）狭窄的疗效数据较少。主要目的是比较真实世界人群中使用新型 DES 和 BMS 治疗 SVG 狭窄的 PCI 患者一年的临床结局。
方法和结果
我们进行了一项多中心注册研究，比较了所有接受 SVG-PCI 的连续患者中新型 DES 和 BMS 的使用情况。主要复合终点是 1 年时的主要不良心脏和脑血管事件（MACCE）。该观察包括 792 例连续患者（平均年龄 69±8.9 岁），分别接受新型 DES（n=379，47.9%）或 BMS（n=413，52.1%）治疗。与 BMS 相比，接受新型 DES 治疗的患者 MACCE（21.4%比 28.3%，HR=0.69，95%CI 0.50-0.95，p=0.025）和心肌梗死（MI）（6.3%比 12.1%，HR 0.49，95%CI 0.30-0.82，p=0.005）的风险较低。经过倾向评分调整后，新型 DES 治疗在 MACCE 和 MI 方面仍有明显降低（HR 0.66，95%CI 0.46-0.96，p=0.030；HR 0.53，95%CI 0.31-0.92，p=0.020）。
结论
在接受 SVG-PCI 的患者中，与 BMS 相比，使用新型 DES 可降低 1 年时 MACCE 和 MI 的发生率。
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