Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
University Heart Center, University Hospital Zürich, Zürich, Switzerland.
Catheter Cardiovasc Interv. 2020 Sep 1;96(3):E204-E212. doi: 10.1002/ccd.28637. Epub 2019 Dec 2.
The aim of this study was to evaluate the very long-term clinical outcome after radioactive stent (RS) implantation and intracoronary β radiation brachytherapy (IRBT).
Radioactive stents (RS) and intracoronary β radiation brachytherapy (IRBT) were introduced to prevent restenosis after percutaneous coronary intervention (PCI). Both techniques were associated with a higher incidence of major adverse cardiac events (MACE) in the short and intermediate-term follow up as compared to conventional PCI.
One hundred and thirty-three patients received radioactive stents ( P) and 301 patients were treated with IRBT adjunctive to PCI. These groups were propensity matched to respectively 266 and 602 control patients who were treated with routine PCI during the same inclusion period. Endpoints were all-cause mortality and MACE, defined as all-cause death, any myocardial infarction or any revascularization.
Median follow-up duration was 17 years. All-cause mortality rates were similar in all groups. Adjusted hazard ratios for MACE and mortality in the RS cohort were 1.55 (95% CI 1.20-2.00) and 0.92 (95% CI 0.63-1.34), respectively. Adjusted hazard ratios for MACE and all-cause mortality in the IRBT cohort were 1.41 (95% CI 1.18-1.67) and 0.95 (95% CI 0.74-1.21), respectively. The difference in MACE rates was predominantly driven by coronary revascularizations in both groups, with a higher MI rate in the IRBT group as well.
Coronary radiation therapy was associated with early increased MACE rates, but the difference in MACE rates decreased beyond 2 years, resulting in a comparable long-term clinical outcome. Importantly, no excess in mortality was observed.
本研究旨在评估放射性支架（RS）植入和冠状动脉内β 射线近距离放射治疗（IRBT）后的长期临床结局。
放射性支架（RS）和冠状动脉内β射线近距离放射治疗（IRBT）被引入以预防经皮冠状动脉介入治疗（PCI）后的再狭窄。与常规 PCI 相比，这两种技术在短期和中期随访中均与更高的主要不良心脏事件（MACE）发生率相关。
133 例患者接受放射性支架（P）治疗，301 例患者接受 IRBT 联合 PCI 治疗。在同一纳入期间，这些组分别与接受常规 PCI 治疗的 266 例和 602 例对照患者进行倾向匹配。终点是全因死亡率和 MACE，定义为全因死亡、任何心肌梗死或任何血运重建。
中位随访时间为 17 年。所有组的全因死亡率相似。RS 队列中 MACE 和死亡率的调整后危险比分别为 1.55（95%CI 1.20-2.00）和 0.92（95%CI 0.63-1.34）。IRBT 队列中 MACE 和全因死亡率的调整后危险比分别为 1.41（95%CI 1.18-1.67）和 0.95（95%CI 0.74-1.21）。两组的 MACE 发生率差异主要归因于血运重建，IRBT 组的心肌梗死发生率也较高。
冠状动脉放射治疗与早期增加的 MACE 发生率相关，但 2 年后 MACE 发生率的差异减小，导致长期临床结局相当。重要的是，没有观察到死亡率的增加。
