Mølstad Per Morten, Nordrehaug Jan Erik, Steigen Terje K, Wilsgaard Tom, Wiseth Rune, Rotevatn Svein, Mannsverk Jan, Larsen Tommy, Larsby Kristina Elisabet, Skarstad Sigrun Ådnegard, Fosse Eivind Øygard, Dahl-Eriksen Øystein, Bønaa Kaare Harald
Department of Cardiology, LHL Clinics Gardermoen, Jessheim, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Cardiology. 2022;147(1):14-22. doi: 10.1159/000521085. Epub 2021 Dec 8.
Drug-eluting stents (DES) reduce target lesion revascularization (TLR) with no effect on mortality or myocardial infarction (MI) compared to bare-metal stents (BMS) in native vessels. Randomized stent studies in saphenous vein grafts (SVG) are few and the reported effects are ambiguous. The Norwegian Coronary Stent Trial study is the first to randomize lesions to percutaneous coronary intervention in native vessels and SVG.
The aim of this study was to compare the rate of mortality, MI, and TLR across stent and vessel types.
In this substudy, 6,087 patients with a single lesion in native vessels and 164 in SVG were followed for 5 years.
MI was more frequent in SVG (subdistributional hazard ratio [SHR] 4.95 (3.75-6.54, p < 0.001), but not affected by stent type. In the first 500 days, DES reduced TLR in native vessels (SHR 0.21 (0.15-0.30) p < 0.001) and SVG (SHR 0.18 (0.04-0.80) p = 0.02). Thereafter, DES and BMS were equivalent in native vessels, but DES had a higher TLR rate than BMS in SVG (SHR 3.31 (1.23-8.94) p = 0.02). After 5 years, the TLR rate was still significantly lower for DES in native vessels (3.2% vs. 7.8%, p < 0.001) but not in SVG (21.4% vs. 18. 4%).
In SVG, no difference in TLR between DES and BMS was observed after 5 years in contrast to persistent benefit in native vessels. The high rate of TLR and MI in SVG makes treatment of native vessels a preference whenever feasible and better treatment options for SVG are warranted.
与裸金属支架（BMS）相比，药物洗脱支架（DES）可降低原位血管靶病变血运重建（TLR）率，但对死亡率或心肌梗死（MI）无影响。关于隐静脉桥（SVG）的随机支架研究较少，且报告的结果不明确。挪威冠状动脉支架试验是首个将原位血管和SVG病变随机分配至经皮冠状动脉介入治疗的研究。
本研究旨在比较不同支架类型和血管类型的死亡率、MI和TLR发生率。
在这项子研究中，对6087例原位血管单发病变患者和164例SVG患者进行了5年随访。
MI在SVG中更常见（亚分布风险比[SHR]4.95（3.75 - 6.54，p < 0.001）），但不受支架类型影响。在最初500天内，DES降低了原位血管（SHR 0.21（0.15 - 0.30）p < 0.001）和SVG（SHR 0.18（0.04 - 0.80）p = 0.02）的TLR率。此后，DES和BMS在原位血管中效果相当，但DES在SVG中的TLR率高于BMS（SHR 3.31（1.23 - 8.94）p = 0.02）。5年后，DES在原位血管中的TLR率仍显著低于BMS（3.2%对7.8%，p < 0.001），但在SVG中并非如此（21.4%对18.4%）。
与原位血管持续获益不同，5年后DES和BMS在SVG中的TLR率无差异。SVG中TLR和MI的高发生率使得在可行时优先治疗原位血管，并需要更好的SVG治疗选择。
