新一代超薄支架与厚壁支架药物洗脱支架在慢性和急性冠状动脉综合征中的差异效应。
Differential Effects of Newer-Generation Ultrathin-Strut Versus Thicker-Strut Drug-Eluting Stents in Chronic and Acute Coronary Syndromes.
机构信息
Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland.
出版信息
JACC Cardiovasc Interv. 2021 Nov 22;14(22):2461-2473. doi: 10.1016/j.jcin.2021.09.028.
OBJECTIVES
The authors sought to compare the differential effects of ultrathin-strut and thicker-strut drug-eluting stents (DES) in patients with chronic (CCS) versus acute (ACS) coronary syndromes.
BACKGROUND
Newest-generation ultrathin-strut DES reduce target lesion failure (TLF) compared with thicker-strut second-generation DES in patients undergoing percutaneous coronary intervention.
METHODS
PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing newer-generation ultrathin-strut (<70 μm) versus thicker-strut (≥70 μm) DES. Patients were divided based on baseline clinical presentation (CCS versus ACS). The primary endpoint was TLF, a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization (TLR).
RESULTS
A total of 22,766 patients from 16 randomized controlled trials were included, of which 9 trials reported TLF rates in ACS patients. At a mean follow-up of 12.2 months, the risk of TLF was lower among patients treated with ultrathin-strut compared with thicker-strut DES (risk ratio [RR]: 0.85; 95% CI: 0.75-0.95; P = 0.006). The difference was driven by a lower risk of clinically-indicated TLR (RR: 0.75; 95% CI: 0.63-0.89; P < 0.001) among patients treated with ultrathin-strut DES. The treatment effect was consistent between patients presenting with CCS and ACS (relative RR: 0.97; 95% CI: 0.73-1.31; P for interaction = 0.854). In patients with ST-segment elevation myocardial infarction, TLF risk was lower among those treated with ultrathin- compared with thicker-strut DES (RR: 0.74; 95% CI: 0.54-0.99; P = 0.049).
CONCLUSIONS
Ultrathin-strut DES reduce the risk of TLF compared with thicker-strut second-generation DES in patients undergoing percutaneous coronary intervention, a difference caused by a lower risk of ischemia-driven TLR. The treatment effect was consistent among patients with CCS and ACS.
目的
作者旨在比较慢性（CCS）和急性（ACS）冠状动脉综合征患者中使用超薄支架和较厚支架药物洗脱支架（DES）的差异影响。
背景
在接受经皮冠状动脉介入治疗的患者中，最新一代超薄支架DES 降低了靶病变失败（TLF）的风险，与较厚支架第二代 DES 相比。
方法
在 PubMed、Embase 和 Cochrane 对照试验中心注册数据库中检索了比较新一代超薄支架（<70μm）与较厚支架（≥70μm）DES 的随机对照试验。根据基线临床表现（CCS 与 ACS）将患者分为两组。主要终点是 TLF，包括心脏死亡、靶血管心肌梗死或临床指示的靶病变血运重建（TLR）的复合终点。
结果
共有来自 16 项随机对照试验的 22766 名患者纳入研究，其中 9 项试验报告了 ACS 患者的 TLF 发生率。在平均 12.2 个月的随访中，与较厚支架 DES 相比，超薄支架 DES 治疗患者的 TLF 风险较低（风险比 [RR]：0.85；95%CI：0.75-0.95；P=0.006）。这一差异的原因是超薄支架 DES 治疗患者的临床指示性 TLR 风险较低（RR：0.75；95%CI：0.63-0.89；P<0.001）。在 CCS 和 ACS 患者中，治疗效果一致（相对 RR：0.97；95%CI：0.73-1.31；P 交互=0.854）。在 ST 段抬高型心肌梗死患者中，与较厚支架 DES 相比，超薄支架治疗患者的 TLF 风险较低（RR：0.74；95%CI：0.54-0.99；P=0.049）。
结论
在接受经皮冠状动脉介入治疗的患者中，与较厚支架第二代 DES 相比，超薄支架 DES 降低了 TLF 的风险，这是由缺血驱动的 TLR 风险降低引起的。在 CCS 和 ACS 患者中，治疗效果一致。
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