雷帕霉素药物洗脱支架在冠心病复杂病变中应用的近远期疗效

目的　评价雷帕霉素药物洗脱支架 (Cypher)应用的临床近、远期疗效。方法　对 2 0 0 2年 4月至 2 0 0 3年 12月期间 4 0 0例冠心病患者 4 15处病变置入 4 5 0个Cypher支架的临床近、远期疗效进行统计学分析。在 4 15处病变中弥漫性病变 12 6处 (30 4 % )、分叉病变 98处 (2 3 6 % )、慢性完全闭塞性病变 5 5处 (13 3% )、支架内再狭窄病变 4 5处 (10 8% )、开口部病变 2 3处 (5 5 % )。结果支架置入成功率为 99 5 % ,术中和住院期间无死亡 ,2例发生急性心肌梗死 ,住院期间主要心脏不良事件发生率为 0 5 % (2 / 4 0 0 ) ,35 7例患者随访超过 6个月 ,1例死于癌症 ,2例发生急性心肌梗死 ,9例进行了靶血管重建 ,主要心脏不良事件发生率为 2 5 %。 6～ 8个月的冠状动脉造影再狭窄率为8 8% (支架内为 3 8% ) ,靶病变重建率为 1 9%。结论　有选择地应用Cypher支架是安全和有效的 ,在适当放宽病变的适应证后 ,其支架内再狭窄率仍明显低于普通金属支架。

Evaluation of short and long-term outcomes of Cypher stent in patients with complicated lesions

Objective To evaluate the short and long-term clinical outcome of Cypher stent in patient s with complex coronary lesions. Methods From April 2002 to De cember 2003, four hundred patients were treated with 450 Cypher stents. Among th e 400 patients, 269 had single vessel disease, 119 double vessel disease and 12 triple vessel disease. As for lesion characteristics, diffuse disease was found in 126 cases (30.4%), bifurcation lesions in 98 cases (23.6%), chronic total o cclusion lesions in 55 cases (13.3%), in-stent restenosis (ISR) in 45 cases (1 0.8%) and ostial lesions in 23 cases (5.5%). Results Succe ss rate of stent implantation was 99.5% (450/452). There was no death during th e procedure and hospitalization. Acute myocardial infarction (AMI) occurred in two patient during hospitalization. The major cardiac event (MACE) rate during hospitalization was 0.5%. Three hundred and fifty-seven patients were follow ed up for 6 months. During the follow-up period AMI occurred in two patients an d target vessel revascularization (TLR) was performed in 9 patients, with a MACE rate of 2.5%. One patient died of cancer. Angiographic follow-up at 6-8 mont hs showed that ISR rate was 8.8% (restenosis within the stents was 3.8%). TLR rate was 1.9 %. Conclusion Cypher stent implantation is safe and effective when used selectively. After appropriately loosing the indication , ISR rate of Cypher stent is still significantly lower than that of bare metal stents.