Kornowski R, Mehran R, Hong M K, Satler L F, Pichard A D, Kent K M, Mintz G S, Waksman R, Laird J R, Lansky A J, Bucher T A, Popma J J, Leon M B
Division of Cardiology, Washington Hospital Center, DC 20010, USA.
Circulation. 1998 Apr 14;97(14):1355-61. doi: 10.1161/01.cir.97.14.1355.
Previous reports have suggested higher procedural and long-term complications among patients treated with multiple stents for diffuse lesions and/or long dissections.
To evaluate procedural success, major complications, and clinical outcomes (> or = 1 year) in a consecutive series of patients treated with multiple (> or = 3) contiguous stents in single lesions, we evaluated in-hospital and long-term (1-year) clinical outcomes in 117 consecutive patients treated with > or = 3 coronary stents compared with a concurrent series of patients treated with 1 or 2 stents (n=1673) between January 1, 1994, and December 31, 1995. Multiple stents were implanted more often in larger vessels, in the right coronary artery or saphenous vein grafts, and for unfavorable lesion characteristics, including long (>20 mm), calcified, ulcerated, thrombotic, and/or flow-obstructing lesions. Overall procedural success was obtained in 97.4% of patients and was similar whether 1 or 2 versus > or = 3 stents were used. Non-Q-wave MI (CK-MB > or = 5 times normal) was more frequent after > or = 3 stents (22.8% versus 13.4%, P=.005). Target lesion revascularization (TLR) was 14.6% for 1 or 2 stents and 13.3% for > or = 3 stents (P=.70). There was no difference in death (2.2% versus 0.9%, P=.34) or Q-wave MI (1.4% versus 0.9%, P=.64) between the two groups (1 or 2 stents versus > or = 3 stents, respectively), and overall cardiac event-free survival was similar during follow-up (P=.70).
Patients treated with multiple (> or = 3) contiguous stents compared with 1 or 2 stents have (1) similar in-hospital procedural success and major complications despite having more unfavorable lesion characteristics, (2) a higher rate of procedural non-Q-wave MI, and (3) similar TLR and overall major cardiac event rates during 1 year of follow-up.
先前的报告表明，对于弥漫性病变和/或长夹层的患者，使用多个支架治疗会有更高的手术及长期并发症发生率。
为评估在单发病变中连续接受多个（≥3个）相邻支架治疗的一系列患者的手术成功率、主要并发症及临床结局（≥1年），我们评估了1994年1月1日至1995年12月31日期间117例连续接受≥3个冠状动脉支架治疗的患者的院内及长期（1年）临床结局，并与同期接受1个或2个支架治疗的一系列患者（n = 1673）进行比较。多个支架更常植入较大血管、右冠状动脉或大隐静脉移植物中，用于治疗不良病变特征，包括长（>20 mm）、钙化、溃疡、血栓形成和/或血流阻塞性病变。97.4%的患者获得了总体手术成功，无论使用1个或2个支架还是≥3个支架，成功率相似。≥3个支架治疗后非Q波心肌梗死（CK-MB≥正常上限5倍）更常见（22.8%对13.4%，P = 0.005）。1个或2个支架组的靶病变血运重建（TLR）率为14.6%，≥3个支架组为13.3%（P = 0.70）。两组（分别为1个或2个支架组与≥3个支架组）的死亡率（2.2%对0.9%，P = 0.34）或Q波心肌梗死发生率（1.4%对0.9%，P = 0.64）无差异，随访期间总体无心脏事件生存率相似（P = 0.70）。
与接受1个或2个支架治疗的患者相比，接受多个（≥3个）相邻支架治疗的患者：（1）尽管病变特征更差，但院内手术成功率和主要并发症相似；（2）手术非Q波心肌梗死发生率更高；（3）随访1年期间TLR和总体主要心脏事件发生率相似。
