单根长支架与重叠多根支架治疗极长冠状动脉病变的比较：手术及临床结果对比
Single Long Stents versus Overlapping Multiple Stents in the Management of Very Long Coronary Lesions: Comparisons of Procedures and Clinical Outcomes.
作者信息
Amirzadegan Alireza, Hasanabadi Mahdi, Saadatagah Seyedmohammad, Afarideh Mohsen, Omidi Negar, Aghajani Hassan, Alidoosti Mohammad, Pourhosseini Hamidreza, Salarifar Mojtaba, Nozari Younes
机构信息
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
J Tehran Heart Cent. 2019 Jul;14(3):94-102.
Different percutaneous coronary intervention (PCI) strategies, including the use of single long stents (SLSs) and overlapping multiple stents (OMSs), have been introduced to treat very long coronary lesions (VLCLs). The aim of this study was to compare procedural and long-term clinical outcomes between SLSs and OMSs in patients with VLCLs. In this historical cohort study, 1709 patients who underwent PCI with the new generation of drug-eluting stents (length ≥38 mm) were stratified into the SLS [PROMUS /Resolute/XIENCE (PRX), (=38 mm), n=1121 (65.59%) and BioMime, (≥40 mm), n=124 (7.26%)] and OMS [(59.43±10.80 mm), n=464 (27.2%)] groups and followed up for 440.93±361.32 days. The study endpoints comprised immediate post-PCI outcomes, major adverse cardiovascular events (MACE), the patient-oriented composite endpoint (POCE), and the device-oriented composite endpoint (DOCE) at the long-term follow-up. The mean age of the patients was 59.28±10.60 years, and 69.6% of them were male. Flow grade 3 (P=0.296) and residual stenosis (P=0.533) were statistically similar between all the groups. A lower level of post-PCI troponin was observed in the BioMime group [14.52 (IQR:10.44-22.42) ng/L; P=0.031] than in the PRX and OMS groups [18.63 (IQR:10.51-34.02) ng/L and 18.96 (IQR:11.17-35.34) ng/L; respectively]. Similarly, the PRX and BioMime groups received lower amounts of the contrast agent [206.29±49.15 mL and 208.06±55.23 mL; respectively] than did the OMS group [265.50±74.69 mL; P<0.001]. There were no statistically significant differences in the incidence of MACE [81 (7.2%), 7 (5.6%), and 28 (6.0%); P=0.603], the POCE [141 (12.6%), 13 (10.5%), and 54 (11.6%); P=0.731], and the DOCE [51 (4.5%), 4 (3.2%), and 21 (4.5%); P=0.791] between the PRX, BioMime, and OMS groups, respectively. In the treatment of VLCLs, the SLS and OMSs appear to have similar clinical outcomes. BioMime ultra-long stents may have comparable results to PRX coronary stents.
为治疗非常长的冠状动脉病变（VLCLs），已引入了不同的经皮冠状动脉介入治疗（PCI）策略，包括使用单个长支架（SLSs）和多个重叠支架（OMSs）。本研究的目的是比较VLCLs患者中SLSs和OMSs的手术及长期临床结局。在这项历史性队列研究中，1709例接受新一代药物洗脱支架（长度≥38mm）PCI的患者被分为SLS组[PROMUS/Resolute/XIENCE（PRX），（=38mm），n=1121（65.59%）和BioMime，（≥40mm），n=124（7.26%）]和OMS组[（59.43±10.80mm），n=464（27.2%）]，并随访440.93±361.32天。研究终点包括PCI术后即刻结局、主要不良心血管事件（MACE）、长期随访时以患者为导向的复合终点（POCE）和以器械为导向的复合终点（DOCE）。患者的平均年龄为59.28±10.60岁，其中69.6%为男性。所有组之间的血流3级（P=0.296）和残余狭窄（P=0.533）在统计学上相似。BioMime组PCI术后肌钙蛋白水平[14.52（IQR：10.44 - 22.42）ng/L；P=0.031]低于PRX组和OMS组[分别为18.63（IQR：10.51 - 34.02）ng/L和18.96（IQR：11.17 - 35.34）ng/L]。同样，PRX组和BioMime组使用的造影剂剂量[分别为206.29±49.15mL和208.06±55.23mL]低于OMS组[265.50±74.69mL；P<0.001]。PRX组、BioMime组和OMS组之间的MACE发生率[81（7.2%），7（5.6%），28（6.0%）；P=0.603]、POCE[141（12.6%），13（10.5%），54（11.6%）；P=0.731]和DOCE[51（4.5%），4（3.2%），21（4.5%）；P=0.791]在统计学上均无显著差异。在VLCLs的治疗中，SLS和OMS似乎具有相似的临床结局。BioMime超长支架可能与PRX冠状动脉支架有相当的结果。
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