药物洗脱支架联用普通金属支架治疗多支冠状动脉病变的疗效评价

目的探讨多支冠状动脉病变患者药物洗脱支架与普通金属支架(普通支架)联用预防再狭窄的疗效及安全性。方法801例行多支冠状动脉内支架置入术达到完全血运重建的冠心病患者分3组。药物洗脱支架组206例、药物洗脱支架与普通支架联用组(联用组)158例及普通支架组437例。比较3组支架术后近期及远期结果。结果3组患者冠心病危险因素、心功能、冠状动脉病变程度、支架术成功率及并发症发生率均无显著差异。术后平均随访(17.3±10.9)个月,总随访率和造影随访率无显著差异。联用组普通支架置入于31.3%的前降支病变(均为A、B1型病变)及81.6%的回旋支病变和69.9%的右冠状动脉病变。与普通支架组相比,药物洗脱支架组和联用组造影再狭窄率明显降低,分别为20.3%vs7.3%和8.8%(P均<0.05),且主要不良心脏事件发生率均较低,分别为18.4%vs6.5%和9.9%(P均<0.05)。但药物洗脱支架组与联用组相比上述各指标无显著差异。结论多支冠状动脉病变患者单用药物洗脱支架或合理联用普通支架后再狭窄率降低,安全性近似,均优于单用普通支架。     

药物洗脱支架或冠状动脉搭桥术对冠状动脉多支病变的疗效观察

目的观察药物洗脱支架（DES）或冠状动脉旁路手术（CABG）对冠状动脉多支病变的疗效。方法回顾性分析350例冠心病患者的临床资料,其中冠脉多支病变220例,行DES置入术148例,行CABG术72例,观察其手术疗效、并发症,并临床随访再发心绞痛、再次血运重建、死亡无事件存活等。结果随访327例患者,随访率93．42％。随访结果：围手术期手术成功率均较高,CABG组70／72（97．22％）,DES组143／148（96．62％）,两组间差异无统计学意义（P〉0．05）。心力衰竭发生率,CABG组14／72（19．44％）,高于DES组12／148（8．10％）,差异有统计学意义（P〈0．05）。死亡率CABG组4／72（5．55％）,略高于DES组6／148（4．05％）,但差异无统计学意义。脑梗塞、心绞痛、多脏器功能衰竭发生率两组间差异均无统计学意义（P〉0．05）。术后（12．0±6．7）个月随访结果：再发心绞痛DES组9／148（6．48％）,高于CABG组2／72（2．7％）,差异有统计学意义（P〈0．05）。靶血管重建,DES组5／148（3．38％）,高于CABG组0／72（0）,两组间差异无统计学意义。结论对于多支冠状动脉病变,CABG组及DES组手术成功率均较高,两组间差异无统计学意义。DES组创伤小、恢复快,围手术期心力衰竭发生率CABG组高于DES组,差异有统计学意义。死亡率两组间差异无统计学意义。远期临床随访,两组均有较好的效果,再发心绞痛及需血运重建,DES组高于CABG组。     

国产药物洗脱支架治疗冠状动脉多支病变临床随访

目的:评价冠状动脉多支病变患者置入≥4枚国产药物洗脱支架(DES)的疗效.方法:2004-11至2006-11就诊于我科接受经皮冠状动脉介入治疗(PCI)的冠心病患者1 127例,其中185例为置入支架≥4枚的多支病变患者,随访院内外主要心脏不良事件(MACE)包括心性死亡、急性心肌梗死和靶病变再次血运重建的发生率.结果:处理冠状动脉病变720处,其中复杂病变525处,置入国产DES 836枚.院内1例高龄患者术后常规抗凝治疗死于脑出血,其余184例临床随访42(30～54)个月,发生急性心肌梗死4例,靶病变再次血运重建12例,院外MACE发生率8.6%.冠状动脉造影随访108例,DES边缘再狭窄5例,支架内再狭窄9例,再狭窄率13.0%.结论:冠状动脉多支病变患者置入≥14枚国产DES长期随访效果满意.     

药物涂层球囊与药物洗脱支架治疗冠状动脉小血管病变的Meta分析

目的 比较药物涂层球囊(DCB)和药物洗脱支架(DES)在冠状动脉(冠脉)小血管病变中的疗效和安全性.方法 通过计算机检索PubMed、The Cochrane Library和Web of Science数据库,检索截止至2019年5月1日正式发表的文献.纳入比较冠脉小血管病变患者使用药物涂层球囊与药物洗脱支架治疗差...     

药物洗脱支架置入术与冠状动脉旁路移植术治疗冠心病多支病变的临床对比研究

目的:探讨药物洗脱支架(DES)治疗冠心病多支冠状动脉(冠脉)病变患者的临床疗效,并与冠脉旁路移植术进行比较.方法:入选2005-01-2008-01在我院行血管重建术的215例冠心病多支冠脉病变患者,其中114例行DES置入术(DES组),101例行冠脉旁路移植术 (CABG组).比较2组住院期和随访期不良心血管事件(死亡、非致死性心肌梗死、再次血管重建术和脑血管意外)的发生情况.结果:2组的临床和冠脉病变特征相似, 与DES组比较,CABG组左主干病变(29.2%∶5.0%,P<0.01)、LVEF<50%发生率(39.7%∶19.2%,P<0.01) 和完全血管重建率(81.2%∶58.8%, P<0.01)较高.住院期2组总体不良心血管事件发生率无明显差异,但CABG组住院期病死率有增高趋势(6.9%∶1.8%,P＞0.05).平均临床随访12～36(17±9)个月,2组总体不良心血管事件发生率仍无明显差异(9.6% ∶13.4%,P＞0.05) ,但DES组再次血管重建的发生率较CABG组有增高趋势(9.8%∶2.1%,P＞0.05).结论:DES置入术应用在冠心病多支冠脉病变患者中安全可行,总体不良心血管事件发生率与CABG无明显差异.     

药物洗脱支架联合药物涂层球囊治疗原位冠状动脉弥漫病变的初步分析

目的：探讨药物洗脱支架（DES）联合药物涂层球囊（DCB）治疗原位冠状动脉弥漫病变的安全性和疗效。方法：纳入2018年1月至2020年12月期间我院行DES联合DCB治疗原位冠状动脉弥漫病变的患者57例。主要研究终点为操作成功。记录患者临床基线资料、介入操作特征和随访结果,评价其安全性和疗效。结果：共有57例患者60个靶病变纳入,患者平均年龄（59.9±10.2）岁,男性43例（75.4%）,33例（57.9%）合并2型糖尿病。平均置入DES(1.4±0.7)枚,平均应用DCB(1.1±0.3)个。50个（83.3%）病变在近段血管直径较大处置入DES,而远段血管直径较小处应用DCB扩张。术前DES治疗节段的参照血管直径大于DCB治疗节段（P<0.001）,且病变长度更长（P<0.001）。DCB治疗节段出现术后夹层16个（26.7%）,其中A型夹层5个（8.3%）,B型夹层11个（18.3%）。所有患者均操作成功,且无院内急性血栓事件发生。在平均随访（18.2±9.2）个月期间,2例（3.5%）患者发生靶病变血运重建,其中1例（1.8%）因支架内再狭窄应用DCB治疗,1例...     

药物洗脱支架置入与冠状动脉旁路移植术治疗糖尿病合并多支病变的近中期疗效分析

目的比较药物洗脱支架(DES)置入与冠状动脉旁路移植术(CABG)治疗糖尿病合并多支病变患者住院时和12个月的临床效果。方法入选2003年7月至2005年12月北京安贞医院645例糖尿病合并多支病变进行血运重建的患者,比较CABG和置入DES组全因死亡、非致死性心肌梗死(M I)、脑血管事件、再次血运重建以及总的心脑血管不良事件(MACCE)发生率。结果 CABG组更多合并有左主干病变、慢性闭塞病变、C型病变和3支病变,完全血运重建较高(P均<0.001);DES组和CABG组总死亡率(P=0.460)、心脏性死亡和非致死性M I复合终点事件(P=0.076)的发生率差异无统计学意义;DES组MACCE、再次血运重建发生率明显增高(P均<0.001)。结论糖尿病合并多支病变患者12个月时CABG有较低MACCE,与再次血运重建发生率较低有关;DES有较高的再次血运重建发生率,与糖尿病较高的再狭窄率和PC I较低的完全血运重建率有关。     

同种和不同种药物洗脱支架治疗冠状动脉药物洗脱支架内再狭窄有效性的系统评价

目的评价同种药物洗脱支架和不同种药物洗脱支架治疗冠状动脉药物洗脱支架内再狭窄的有效性。方法计算机检索Pub Med、OVID、Embase、Cochrane图书馆、万方数据库、中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、维普数据库(VIP),收集同种和不同种药物洗脱支架治疗冠状动脉药物洗脱支架内再狭窄的临床资料,共纳入10项研究,1680名患者,使用Rev Man5.2软件进行系统评价。检索时间为各大数据库建库至2015年10月。结果在治疗冠状动脉药物洗脱支架内再狭窄时,采用不同药物洗脱支架可降低靶病变血运重建率(OR=0.73,95%CI为0.55~0.96,P=0.02)和主要不良心血管事件发生率(OR=0.72,95%CI为0.54~0.96,P=0.03)。两组间的病死率(OR=1.03,95%CI为0.49~2.16,P=0.95)和心肌梗死发生率(OR=0.59,95%CI为0.24~1.41,P=0.23)无统计学差异。结论对于药物洗脱支架内再狭窄患者,再次植入不同药物洗脱支架比植入同种支架更获益。     

药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉多支病变的比较

目的比较药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉复杂多支病变的疗效。方法连续入选行血运重建治疗的冠心病多支病变患者200名,随机分为经皮冠状动脉介入(PCI)组和冠状动脉旁路移植术(CABG)组,每组100例。PCI组和CABG组中分别有合并糖尿病者(糖尿病亚组)27例和25例。观察术后1年内主要心脑血管不良事件(死亡、脑卒中、非致死性心肌梗死、靶血管再次血运重建)、再狭窄、心绞痛复发发生率,血浆肌酸激酶水平和PCI组支架内血栓形成发生率。结果两组患者的基线特征差异无统计学意义。PCI组与CABG组1个月、6个月和1年的主要心脑血管不良事件发生率分别为4.0%、7.0%、12.0%比6.0%、9.0%、15.2%(P>0.05);心绞痛复发率分别为2.0%、4.0%、6.0%比1.0%、3.0%、5.1%(P>0.05)。术后1年再狭窄率分别为11.3%比13.2%(P>0.05)。PCI组术后亚急性血栓形成率1.0%。PCI组和CABG组术后肌酸激酶MB型同工酶升高的患者比例分别为26%比82%(P<0.05)。PCI组糖尿病亚组与CABG组糖尿病亚组1个月、6个月和1年的严重心脑血管不良事件发生率分别为7.4%、11.1%、18.5%比8.0%、16.0%、24.0%(P>0.05)。结论药物洗脱支架时代PCI与CABG治疗冠状动脉多支病变的近、远期疗效相近,对于合并糖尿病的患者同样有效。     

药物涂层球囊治疗冠状动脉药物洗脱支架内再狭窄临床分析

目的分析药物涂层球囊(DCB)在治疗冠状动脉药物涂层支架内再狭窄病变中的疗效。方法回顾性分析20例冠状动脉药物洗脱支架内再狭窄患者接受药物涂层球囊治疗的临床资料及随访结果。结果 20例患者共21处再狭窄病变接受DCB治疗,术中即刻成功率95.23%,1处病变在应用DCB治疗后并发夹层并出现TIMI 2级血流,然后植入药物洗脱支架(DES)治疗。所有病例术后随访至今无心绞痛再发,未发生主要心血管不良事件。其中12例患者在术后6~9个月接受冠状动脉造影复查,复查时靶病变最小管腔直径与术后即刻直径比较,按病变血管统计,差异无统计学意义(P0.05);合计统计比较差异有统计学意义(P0.05)。结论 DCB治疗DES支架内再狭窄即刻及短期疗效肯定,可以作为支架内再狭窄的一种新的治疗手段。     

老年冠心病患者药物涂层支架植入术的初步结果观察

目的评估老年冠心病患者药物涂层支架的疗效和安全性。方法98例植入药物支架的冠心病患者中,稳定型心绞痛21例、不稳定型29例,心肌梗死48例。冠心病造影示:单支血管病变39例,双支血管病变29例、3支血管病变30例。共处理病变血管138处,置入药物涂层支架116枚。其中左前降支55处,右冠状动脉42处,左回旋支40处,左主干1处。比较A组(≥60岁)和B组(<60岁)的临床特点,冠状动脉病变情况及经皮冠状动脉血管成形术和植入涂层支架的临床疗效。结果A组多支血管病变较之B组增多(P<0.01),两组手术成功率无统计学差异。结论药物涂层支架术安全、有效,成功率高、严重并发症少,也适用于60岁以上患者。     

Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.     

冠心病并糖尿病患者使用药物支架与普通支架初步随访结果比较

目的 :观察药物支架在冠心病并糖尿病患者介入治疗的临床疗效。方法 :并发糖尿病的冠心病患者70例常规冠状动脉造影 ,进行经皮冠状动脉介入治疗 ,其中 32例置入雷帕霉素药物涂层支架 ,38例置入普通支架 ,术前术后常规使用阿司匹林和噻氯吡啶 ,术后进行随访。结果 :冠状动脉造影显示 2支以上血管病变占70 .5 6 % ,一共置入雷帕霉素药物涂层支架 5 4枚 ,普通支架 6 2枚 ,所有患者均获得成功。平均随访 (10 .2± 3.5 )个月 ,其中药物支架组复发心绞痛 9例 ,5例发生心肌梗死 ;普通组复发心绞痛 2 0例 ,8例发生心肌梗死 ,所有患者均再次进行冠状动脉造影 ,药物支架内发生再狭窄 4例 ,普通支架内发生再狭窄 2 0例 ,均进行了靶病变重建术。结论 :药物涂层支架对冠心病并发糖尿病患者近期和远期疗效确切 ,能减少再狭窄的发生     

Polymer‐free drug‐eluting stents for coronary artery disease

Polymer‐free drug‐eluting stents (PF‐DES) were designed with the expectation of avoiding late restenosis and thrombosis related to the polymer used in traditional DES platforms. Furthermore, due to similarities with bare metal stents after drug elution, PF‐DES has been considered as particularly suitable for patients at high bleeding risk. A variety of PF‐DES platforms have been clinically tested. Despite their theoretical advantages, PF platforms showed comparable clinical outcomes with modern permanent‐ or biodegradable polymer‐based DES up to 5 years after implantation. Use of more biocompatible polymers on the modern DES platforms is one of the reasons therefore. Their improved safety profile allows already less intensive antithrombotic regimes after DES. Hence, nowadays PF‐DES platforms can be considered as one of many DES options for percutaneous treatment of coronary artery disease.

     

Therapeutic effect of rotational atherectomy with implantation of drug eluting stent in heavily coronary calcified patients

Background Rotational atherectomy (RA) could facilitate the percutaneous coronary intervention (PCI) in heavily coronary calcified patients. The effectiveness and safety of this technique needs to be further evaluated. Methods & Results Eighty patients who underwent RA in our center from September 2011 to June 2014 were enrolled. The mean age was 72.4 ± 10.4 years. The left ventricular ejection fraction (LVEF) was average 52.3% ± 8.48% and the estimated glomerular filtration rate was 73.2 ± 3.20 mL/min per 1.73 m². The coronary lesions were complex, with Syntax score 29.5 ± 9.86. The diameter of reference vessel was 3.4 ± 0.45 mm and the average diameter stenosis of target vessels was 80% ± 10%. All the patients were deployed with drug eluting stents (DES) successfully after RA. The patients were followed up for 12–18 months. Kaplan-Meier plots estimated the survival rate was 93.4% and the cumulative incidence of major adverse cardiac and cerebral events (MACCE) was 25.4%. Bleeding and procedural-related complications were quite low. COX proportional hazards model for multivariate analysis demonstrated that diabetes, LVEF and maximum pressure of postdilatation were the predictors of MACCE. Conclusions RA followed by implantation of DES was effective and safe for heavily coronary calcified patients. Diabetes, LVEF and maximum pressure of postdilatation were predictive for MACCE.     

药物洗脱支架治疗支架内再狭窄的对照研究

目的 比较3种药物洗脱支架(DES)治疗支架内再狭窄的长期临床效果.方法 回顾性分析阜外医院对支架内再狭窄病例用DES行经皮冠状动脉介入治疗(PCI)的390例患者,其中雷帕霉素药物洗脱支架(Cypher)组187例(C组),紫杉醇药物涂层支架(Taxus)组89例(T组),国产雷帕霉素涂层支架(Firebird)组114例(F组).结果 T组不稳定性心绞痛比率高于另2组,F组左主干病变比率低于另2组,而3支病变比率高于另2组.3组平均临床随访时间为864、848和719 d,主要不良心脏事件发生率差异无统计学意义(P=0.081),3组总的支架内血栓发生率差异无统计学意义(P=0.605).7个月造影随访支架内和血管段再狭窄率T组有增高的趋势(17.9%比29.4%比13.6%.P=0.214和21.8%比35.3%比15.9%,P=0.132).支架内和血管段的晚期丢失T组均明显大于另外2组[(0.31±0.12)mm比(0.75±0.24)mm比(0.31±0.13)mm,P=0.000和(0.33±0.18)mm比(0.61±0.23)mm比(0.31±0.14)mm,P=0.001].结论 3种DES治疗支架内再狭窄病变的长期疗效相似,Cypher和Firebird抑制内膜增生的作用更强.     

Biodegradable polymer stents vs second generation drug eluting stents:A meta-analysis and systematic review of randomized controlled trials

AIM: To evaluate the premise, that biodegradable polymer drug eluting stents(BD-DES) could improve clinical outcomes compared to second generation permanent polymer drug eluting stents(PP-DES), we pooled the data from all the available randomized control trials(RCT) comparing the clinical performance of both these stents.METHODS: A systematic literature search of Pub Med, Cochrane, Google scholar databases, EMBASE, MEDLINE and SCOPUS was performed during time period of January 2001 to April 2015 for RCT and comparing safety and efficacy of BD-DES vs second generation PP-DES. The primary outcomes of interest were definite stent thrombosis, target lesion revascularization, myocardial infarction, cardiac deaths and total deaths during the study period. RESULTS: A total of 11 RCT's with a total of 12644 patients were included in the meta-analysis, with 6598 patients in BD-DES vs 6046 patients in second generation PP-DES. The mean follow up period was 16 mo. Pooled analysis showed non-inferiority of BD-DES, comparing events of stent thrombosis(OR = 1.42, 95%CI: 0.79-2.52, P = 0.24), target lesion revascularization(OR = 0.99, 95%CI: 0.84-1.17, P = 0.92), myocardial infarction(OR = 1.06, 95%CI: 0.86-1.29, P = 0.92), cardiac deaths(OR = 1.07, 95%CI 0.82-1.41, P = 0.94) and total deaths(OR = 0.96, 95%CI: 0.80-1.17, P = 0.71).CONCLUSION: BD-DES, when compared to second generation PP-DES, showed no significant advantage and the outcomes were comparable between both the groups.