Dipartimento Cardiovascolare, Ospedale Cà Foncello.
Fondazione Ivone Dal Negro, Treviso.
J Cardiovasc Med (Hagerstown). 2020 Jun;21(6):444-452. doi: 10.2459/JCM.0000000000000955.
The availability of bare metal stents (BMS) followed by drug-eluting stents of first- (DES1) and second-generation (DES2) progressively increased the rate of the percutaneous revascularizations [percutaneous coronary intervention (PCI)] with unknown impact on the long-term outcome of real-world patients with established coronary artery disease. We sought to investigate treatments applied in patients with coronary artery disease in BMS, DES1 and DES2 eras and their 5-year outcome.
A total of 3099 consecutive patients with at least one coronary stenosis more than 50% observed in 2002 (BMS era), 2005 (DES1 era) and 2011(DES2 era) were enrolled at 13 hospitals in Veneto region, Italy.
Moving from BMS to DES1 and DES2 eras patients became significantly older, had more comorbidities and received more frequently statins, betablockers, renin-angiotensin modulators and antiplatelets (P < 0.0001 for all). The PCI/conservative therapy ratio increased from 1.9 to 2.2 and 2.3, the PCI/coronary artery by-pass surgery ratio from 3.6 to 4.0 and 5.1. The crude 5-year survival was 84.9, 83.4 and 81.4% (P = 0.20) and survival free of myocardial infarction, stroke or further revascularizations was 62.1, 60.2 and 60.1% (P = 0.68), with cardiovascular mortality accounting for 60.9, 55.6 and 43.4% of deaths. At multivariable analysis cardiovascular mortality was significantly lower in patients enrolled in 2011 vs. 2002 (hazard ratio = 0.712, 95% confidence interval 0.508-0.998, P = 0.048).
From BMS to DES1 and DES2 eras progressive worsening of patients characteristics, improvement of medical treatment standards and increase in PCI/conservative therapy and PCI/coronary artery by-pass surgery ratios were observed. Five-year outcomes remained similar in the three cohorts, but in the DES2 era cardiovascular mortality was reduced.
裸金属支架（BMS）的应用，以及第一代（DES1）和第二代（DES2）药物洗脱支架的相继出现，提高了经皮血运重建术（经皮冠状动脉介入治疗 [PCI]）的比例，但对已确诊冠心病患者的长期预后的影响尚不清楚。我们旨在研究 BMS、DES1 和 DES2 时代冠心病患者的治疗方法及其 5 年的结果。
2002 年（BMS 时代）、2005 年（DES1 时代）和 2011 年（DES2 时代），在意大利威尼托地区的 13 家医院共纳入了 3099 例至少有一处冠状动脉狭窄超过 50%的连续患者。
从 BMS 时代到 DES1 时代和 DES2 时代，患者年龄明显增大，合并症更多，他汀类药物、β受体阻滞剂、肾素-血管紧张素调节剂和抗血小板药物的应用更加频繁（所有 P 值均＜0.0001）。PCI/保守治疗的比例从 1.9 增加到 2.2 和 2.3，PCI/冠状动脉旁路移植术的比例从 3.6 增加到 4.0 和 5.1。5 年的粗生存率为 84.9%、83.4%和 81.4%（P=0.20），无心肌梗死、中风或再次血运重建的生存率为 62.1%、60.2%和 60.1%（P=0.68），心血管死亡率占死亡人数的 60.9%、55.6%和 43.4%。多变量分析显示，2011 年与 2002 年相比，心血管死亡率显著降低（风险比=0.712，95%置信区间 0.508-0.998，P=0.048）。
从 BMS 时代到 DES1 时代和 DES2 时代，患者特征逐渐恶化，药物治疗标准不断提高，PCI/保守治疗和 PCI/冠状动脉旁路移植术的比例也不断增加。三个队列的 5 年结果相似，但在 DES2 时代，心血管死亡率降低。
