Chandrasekhar Jaya, Kalkman Deborah N, Sartori Samantha, Baber Usman, Blum Moritz, Aquino Melissa B, Woudstra Pier, Beijk Marcel A, Tijssen Jan G, Koch Karel T, Dangas George D, Colombo Antonio, de Winter Robbert J, Mehran Roxana
Icahn School of Medicine at Mount Sinai Hospital, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, USA.
Amsterdam UMC, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
Catheter Cardiovasc Interv. 2020 Sep 16. doi: 10.1002/ccd.29270.
Chronic kidney disease (CKD) patients undergoing percutaneous coronary intervention (PCI) experience greater ischemic events including clinically driven target lesion revascularization (CD-TLR). Whether the COMBO biodegradable-polymer sirolimus-eluting stent promotes better outcomes in these patients by virtue of endothelial progenitor cell capture technology is unknown.
We examined one-year outcomes by CKD status from the COMBO collaboration.
The COMBO collaboration was a patient-level pooled dataset from the REMEDEE and MASCOT registries (3,614 patients) of all-comers undergoing attempted COMBO stent PCI. The primary endpoint was one-year target lesion failure (TLF), composite of cardiac death, target-vessel myocardial infarction (TV-MI) or CD-TLR. Secondary endpoints included stent thrombosis (ST).
The study included 6.4% (n = 231) CKD and 93.6% (n = 3,361) non-CKD patients. CKD patients were older and included more women with greater prevalence of several comorbidities but similar rate of acute coronary syndrome (50.6% vs. 54.5%, p = .26). CKD patients underwent radial PCI less often (56.1% vs. 70.3%, p < .001) and received clopidogrel (78.6% vs. 68.3%) more often (p = .004). One-year TLF occurred in 7.9% CKD vs. 3.7% non-CKD patients, p = .001. CKD patients also demonstrated greater incidence of cardiac death (6.2% vs. 1.2%, p < .0001), TV-MI (2.7% vs. 1.1%, p = .04) but similar CD-TLR (2.7% vs 2.2%, p = .61) and definite/probable ST (1.4% vs. 0.8%, p = .42), compared to non-CKD patients.
CKD patients treated with COMBO stents had significantly greater incidence of one-year TLF compared to non-CKD patients driven by cardiac death and to a lesser extent TV-MI but not CD-TLR. They had similar rates of definite/probable ST.
接受经皮冠状动脉介入治疗（PCI）的慢性肾脏病（CKD）患者发生缺血事件的风险更高，包括因临床需求进行的靶病变血运重建（CD-TLR）。目前尚不清楚COMBO可生物降解聚合物西罗莫司洗脱支架凭借内皮祖细胞捕获技术是否能在这些患者中带来更好的治疗效果。
我们通过COMBO合作研究，按CKD状态分析了一年的治疗结果。
COMBO合作研究是一项患者水平的汇总数据集，来自REMEDEE和MASCOT注册研究（共3614例患者），这些患者均尝试接受COMBO支架PCI治疗。主要终点是一年的靶病变失败（TLF），定义为心源性死亡、靶血管心肌梗死（TV-MI）或CD-TLR的复合终点。次要终点包括支架血栓形成（ST）。
该研究纳入了6.4%（n = 231）的CKD患者和93.6%（n = 3361）的非CKD患者。CKD患者年龄更大，女性更多，合并多种疾病的患病率更高，但急性冠状动脉综合征的发生率相似（50.6%对54.5%，p = 0.26）。CKD患者接受桡动脉PCI的比例较低（56.1%对70.3%，p < 0.001），而接受氯吡格雷治疗的比例较高（78.6%对68.3%，p = 0.004）。一年的TLF发生率在CKD患者中为7.9%，在非CKD患者中为3.7%，p = 0.001。与非CKD患者相比，CKD患者的心源性死亡发生率也更高（6.2%对1.2%，p < 0.0001），TV-MI发生率更高（2.7%对1.1%，p = 0.04），但CD-TLR发生率相似（2.7%对2.2%，p = 0.61），明确/可能的ST发生率相似（1.4%对0.8%，p = 0.42）。
与非CKD患者相比，接受COMBO支架治疗的CKD患者一年TLF发生率显著更高，主要是由心源性死亡导致，在较小程度上由TV-MI导致，但CD-TLR发生率无差异。他们明确/可能的ST发生率相似。
