药物洗脱支架治疗冠状动脉小血管病变的疗效分析

目的通过分析比较裸金属支架(BMS)与药物洗脱支架DES,包括雷帕霉素(Cypher)支架和紫杉醇(TAXUS)支架]治疗冠状动脉小血管病变疗效的差异,为DES治疗多支及单支小血管病变冠心病提供依据。方法连续入选2002年12月至2005年5月沈阳军区总医院首次接受经皮冠状动脉介入治疗(PCI)、靶血管为小血管病变且达到完全血运重建的486例患者,其中多支小血管病变(多支)150例。分为BMS组214例(多支63例)、Cypher组140例(多支46例)和TAXUS组132例(多支41例),对比分析各组患者住院期间及随访6个月的临床情况。结果3组患者冠脉病变特点、PCI成功率及住院期间主要不良心脏事件(MACE)发生率等指标差异均无显著性(P>0·05)。冠脉造影随访显示,两个DES组再狭窄率均明显低于BMS(Cypher组4·9%,TAXUS组7·5%对BMS组29·2%,P<0·05),随访期间MACE发生率亦明显低于BMS(Cypher组2·9%,TAXUS组3·9%对BMS组12·0%,P<0·01)。进一步分析多支小血管病例,发现两个DES组的再狭窄率及随访期间MACE发生率仍然明显低于BMS组(再狭窄率Cypher组6·7%,TAXUS组7·1%对BMS组37·5%,P<0·05;MACE发生率Cypher组4·1%,TAXUS组4·8%对BMS组21·0%,P<0·05)。结论Cypher和TAXUS支架治疗小血管病变安全可行,疗效显著,治疗多支小血管病变可得到相同的疗效。

Effectiveness of drug eluting stents in patients with small coronary artery lesions

Objective To assess the safety and effectiveness of the drug eluting stents(DES,including Cypher and TAXUS stent)in treating patients with single- and multi-vessel de novo lesions located in small native coronary arteries with comparison of bare metal stent(BMS).Methods From December 2002 to May 2005,coronary stenting procedures were performed in 407 patients with small coronary artery lesions consecutively(among whom 150 patients with multi-vessel small coronary lesion).There were 214 patients(63 patients with multi-vessel)in BMS group,140 patients(46 patients with multi-vessel)in Cypher group and 132 patients(41 patients with multi-vessel)in TAXUS group.The results of in-hospital and 6-month clinical follow-up were analysed among the 3 groups.Results There were no differences in lesion characteristic,success rate of percutanous coronary intervention(PCI),in-hospital major adverse cardiac events(MACE)and in-stent minimal lumen diameter after PCI among 3 groups.However,angiographic restenosis occurred significantly less in two DES groups than in BMS group(4.9%in Cypher group and 7.5%in TAXUS group vs 29.2% in BMS group,P<0.05).Accordingly,MACE at 6-month follow-up differed significantly between two DES groups and BMS group(6.3%in Cypher group and 9.4% in TAXUS group vs 26.1% in BMS group,P<0.01).The subgroups analysis for 150 patients with small and multi-vessel coronary lesion found that the angiographic restenosis and MACE at 6-month follow-up were significantly decreased in two DES groups compared with BMS groups(restenosis rate 6.7%in Cypher group,7.1%in TAXUS group vs 37.5%in BMS group,P<0.05;MACE 4.1% in Cypher group,4.8% in TAXUS group vs 21.0% in BMS group,P<0.05).Conclusion Both Cypher and TAXUS stenting therapy are safe and efficient in patients with small coronary lesion,and the same ideal outcomes are obtained in subgroup patients with small and multivessel coronary lesions.