NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (M.V.M., B.R., Z.A.A., M.P., A.M., M.B.L., A.J.K.).
Cardiovascular Research Foundation, New York, NY (M.V.M., B.R., Z.A.A., M.P., B.S., Z.Z., R.M., A.M., M.B.L., A.J.K., G.W.S.).
Circ Cardiovasc Interv. 2020 Apr;13(4):e008565. doi: 10.1161/CIRCINTERVENTIONS.119.008565. Epub 2020 Apr 13.
Whether revascularization improves prognosis in stable ischemic heart disease is controversial.
Individual patient-level data from 19 prospective, randomized stent trials were pooled. Rates of 5-year major adverse cardiovascular events (MACE; a composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed and compared after percutaneous coronary intervention with bare-metal stents (BMS) and first-generation and second-generation drug-eluting stents (DES1 and DES2, respectively). Poisson multivariable regression analysis was performed to identify predictors of adverse events.
Among 10 987 patients treated with percutaneous coronary intervention for stable ischemic heart disease, 1550, 2776, and 6661 received BMS, DES1, and DES2, respectively. The 5-year rates of MACE progressively declined with evolution in stent technology (BMS: 24.1% versus DES1: 17.9% versus DES2: 13.4%, <0.0001). However, MACE rates between 1 and 5 years increased from BMS to DES1, then declined with DES2 (BMS: 7.4% versus DES1: 10.2%, DES2: 8.5%, =0.02).
Patients with stable ischemic heart disease remain at substantial risk for long-term MACE after revascularization with percutaneous coronary intervention, even with contemporary DES. New approaches to reduce the ongoing risk of MACE beyond 1 year after stent implantation are necessary.
血运重建是否能改善稳定性缺血性心脏病患者的预后仍存在争议。
汇总了 19 项前瞻性、随机支架试验的个体患者水平数据。经皮冠状动脉介入治疗（PCI）后，采用裸金属支架（BMS）、第一代和第二代药物洗脱支架（DES1 和 DES2），评估并比较 5 年主要不良心血管事件（MACE；心脏死亡、心肌梗死或缺血驱动的靶病变血运重建的复合终点）发生率。采用泊松多变量回归分析确定不良事件的预测因素。
在 10987 例因稳定性缺血性心脏病行 PCI 治疗的患者中，1550 例、2776 例和 6661 例分别接受 BMS、DES1 和 DES2 治疗。随着支架技术的发展，MACE 的 5 年发生率逐渐下降（BMS：24.1%比 DES1：17.9%比 DES2：13.4%，<0.0001）。然而，MACE 发生率在 1 至 5 年之间从 BMS 增加到 DES1，然后随 DES2 下降（BMS：7.4%比 DES1：10.2%比 DES2：8.5%，=0.02）。
即使使用当代 DES，经 PCI 血运重建后，稳定性缺血性心脏病患者仍存在长期发生 MACE 的高风险。需要采取新方法降低支架植入后 1 年以上的 MACE 持续风险。
