大隐静脉移植血管内支架再狭窄（来自DIVA试验）

In-Stent Restenosis in Saphenous Vein Grafts (from the DIVA Trial).

作者信息

Xenogiannis Iosif, Rangan Bavana V, Uyeda Lauren, Banerjee Subhash, Edson Robert, Bhatt Deepak L, Goldman Steven, Holmes David R, Rao Sunil V, Shunk Kendrick, Mavromatis Kreton, Ramanathan Kodangudi, Bavry Antony A, McFalls Edward O, Garcia Santiago, Thai Hoang, Uretsky Barry F, Latif Faisal, Armstrong Ehrin, Ortiz Jose, Jneid Hani, Liu Jayson, Aggrawal Kul, Conner Todd A, Wagner Todd, Karacsonyi Judit, Ventura Beverly, Alsleben Aaron, Lu Ying, Shih Mei-Chiung, Brilakis Emmanouil S

机构信息

Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota.

Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California.

出版信息

Am J Cardiol. 2022 Jan 1;162:24-30. doi: 10.1016/j.amjcard.2021.09.024. Epub 2021 Nov 1.

DOI:10.1016/j.amjcard.2021.09.024

PMID:34736721

Abstract

Saphenous vein grafts (SVGs) have high rates of in-stent restenosis (ISR). We compared the baseline clinical and angiographic characteristics of patients and lesions that did develop ISR with those who did not develop ISR during a median follow-up of 2.7 years in the DIVA study (NCT01121224). We also examined the ISR types using the Mehran classification. ISR developed in 119 out of the 575 DIVA patients (21%), with similar incidence among patients with drug-eluting stents and bare-metal stents (BMS) (21% vs 21%, p = 0.957). Patients in the ISR group were younger (67 ± 7 vs 69 ± 8 years, p = 0.04) and less likely to have heart failure (27% vs 38%, p = 0.03) and SVG lesions with Thrombolysis In Myocardial Infarction 3 flow before the intervention (77% vs 83%, p <0.01), but had a higher number of target SVG lesions (1.33 ± 0.64 vs 1.16 ± 0.42, p <0.01), more stents implanted in the target SVG lesions (1.52 ± 0.80 vs 1.31 ± 0.66, p <0.01), and longer total stent length (31.37 ± 22.11 vs 25.64 ± 17.42 mm, p = 0.01). The incidence of diffuse ISR was similar in patients who received drug-eluting-stents and BMS (57% vs 54%, p = 0.94), but BMS patients were more likely to develop occlusive restenosis (17% vs 33%, p = 0.05).

摘要

大隐静脉移植血管（SVG）的支架内再狭窄（ISR）发生率很高。在DIVA研究（NCT01121224）中，我们比较了在中位随访2.7年期间发生ISR的患者和病变与未发生ISR的患者和病变的基线临床及血管造影特征。我们还使用梅兰分类法检查了ISR类型。DIVA研究的575例患者中有119例（21%）发生了ISR，药物洗脱支架和裸金属支架（BMS）患者的发生率相似（21%对21%，p = 0.957）。ISR组患者更年轻（67±7岁对69±8岁，p = 0.04），发生心力衰竭的可能性更小（27%对38%，p = 0.03），干预前心肌梗死溶栓3级血流的SVG病变更少（77%对83%，p<0.01），但目标SVG病变数量更多（1.33±0.64对1.16±0.42，p<0.01），目标SVG病变中植入的支架更多（1.52±0.80对1.31±0.66，p<0.01），总支架长度更长（31.37±22.11对25.64±17.42 mm，p = 0.01）。接受药物洗脱支架和BMS的患者弥漫性ISR发生率相似（57%对54%，p = 0.94），但BMS患者发生闭塞性再狭窄的可能性更大（17%对33%，p = 0.05）。