冠心病患者应用紫杉醇与国产雷帕霉素洗脱支架的随机对照研究

目的:观察冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架后临床不良心血管事件的发生率。方法:本研究为随机开放平行对照研究,共入选患者168例,雷帕霉素支架组83例,紫杉醇支架组85例。两组患者在年龄,性别组成,吸烟比例,糖尿病比例,血压水平,总胆固醇水平,冠状动脉病变支数,冠状动脉病变积分(Gensini法),左心室射血分数均无统计学上的差异。术后严格要求患者服用阿司匹林和噻氯匹定或氯比格雷9个月。通过门诊或电话随访术后患者临床不良心血管事件的发生率,部分患者进行了冠状动脉造影复查。结果:平均随访10.6个月,失访患者3例(包括2例雷帕霉素支架组患者与1例紫杉醇支架组患者),失访率为1.79%。在随访的81例雷帕霉素支架组共7例(8.64%)发生了临床不良心血管事件。在随访到的84例紫杉醇支架组8例(9.52%)患者发生了不良心血管事件。以上2组患者不良心血管事件发生率差异无统计学意义(卡方检验P>0.05)。雷帕霉素支架组冠状动脉造影再狭窄率为200%(3/15),紫杉醇支架组冠状动脉造影再狭窄率为25%(6/24),两组之间无统计学差异(P>0.05)。结论:短期临床随访结果表明,冠心病患者应用雷帕霉素洗脱支架与紫杉醇洗脱支架临床心血管事件的发生率较低,两组无统计学差异。冠状动脉造影复查两组再狭窄率无统计学差异     

急性冠脉综合征患者药物洗脱支架雷帕霉素CypherTM植入后的不良反应分析

目的:分析雷帕霉素药物洗脱支架CypherTM植入后对急性冠脉综合征患者近、远期的不良反应.方法: 选择接受CypherTM治疗的冠心病患者83例,在支架植入术后9个月内全部接受门诊随访及冠脉造影,了解支架内急性和亚急性血栓、边缘效应、贴壁不良现象、支架处动脉瘤发生率及相应的不良心脏事件(MACE)发生情况.结果:83例患者共植入支架112个,植入成功率为98.8%(82/83).29例(34.9%)接受冠脉造影,MACE9例,发生率10.8%(9/83),其中,1例术中发生猝死,1例术后3d因亚急性血栓造成再发心肌梗死,其余7例在出院后1～3 月内发生心绞痛,皆经造影证实为血栓形成,再次成功靶血管血运重建8例;其余20例无症状患者造影发现支架边缘狭窄(无血栓)2例,总再狭窄为13.3%(11/83);无动脉瘤发生.9例MACE中,有弥漫病变5例,其中4例植入长支架,1例植入重叠支架,其余为简单病变;29例患者共发现贴壁不良现象5例,皆发生MACE,其中4例为弥漫病变植入长支架,1例为简单病变.结论:急性或亚急性血栓形成是药物支架CypheTM植入后出现的主要不良反应,可能与弥漫病变植入长、重叠支架引起贴壁不良有关.     

Cypher~(TM)支架治疗冠心病的疗效观察

目的评价雷帕霉素洗脱冠状动脉支架(CypherTM)应用于冠心病的临床疗效及再狭窄情况。方法选择接受CypherTM支架治疗的348例冠心病患者,观察术后即刻效果、术后6个月心脏性死亡、心肌梗死、再次血管重建及冠状动脉造影复查情况。病例中包括ST段抬高的急性心肌梗死86例,非ST段抬高的急性心肌梗死21例,不稳定型心绞痛149例,稳定型心绞痛92例。结果支架植入成功率99.3%,住院期间无死亡,术后出现急性和亚急性血栓各1例,1例晚期血栓致心肌梗死,1例心衰死亡,另有5例随访中进行了血管重建术,术后6个月主要心脏不良事件发生率2.9%。术后6个月56例冠状动脉造影复查的再狭窄率为7.1%(支架内为1.8%),支架内平均晚期管腔丢失为0.16mm(病变段内为0.20mm),靶病变重建率为5.4%。结论应用CypherTM支架治疗冠心病是安全和有效的,主要心脏不良事件发生率低,支架内再狭窄率和靶病变重建率明显低于普通金属支架。     

糖尿病患者植入雷帕霉素药物洗脱支架的疗效分析

目的:评价糖尿病对雷帕霉素药物洗脱支架临床疗效的影响。方法:选择2002年12月至2005年5月应用雷帕霉素药物洗脱支架(Cypher)的冠心病合并糖尿病患者262例(糖尿病组)和非糖尿病患者262例(对照组),平均随访8个月,患者均复查冠状动脉造影,分析不良心脏事件(心性死亡,急性心肌梗死或靶病变重建)和冠状动脉造影复查结果,评价糖尿病对Cypher支架临床近远期疗效的影响。结果:1.2组支架植入成功率均为100%,糖尿病组无死亡,6例于术后第2天发生急性心肌梗死,对照组无死亡,11例于随访6个月时发生急性心肌梗死;2.复查冠状动脉造影显示糖尿病组和对照组晚期管腔绝对内径丢失分别为(0.06±0.02)mmvs(0.04±0.02)mm(P>0.05),相对内径丢失分别为(2.32±0.19)%vs(1.63±0.14)%(P=0.03)。因再狭窄行靶血管重建者分别为33例(12.60%)和26例(9.92%)(P>0.05)。回归分析显示,相关血管大小和相对管腔内径丢失与再狭窄有关。结论:糖尿病患者应用Cypher支架安全有效,但相对内径丢失明显,糖尿病合并小血管可能是雷帕霉素药物洗脱支架再狭窄的影响因素。     

真实临床条件下CypherTM支架的应用效果评价

目的　观察在真实临床条件(realworld)下使用西罗莫司(雷帕霉素)药物CypherTM 支架的疗效。方法　入选我科自2 0 0 2年1 2月至2 0 0 4年5月所有应用CypherTM 支架的患者,共2 6 3例,于支架置入后8±2个月,电话及门诊随访应用药物洗脱支架患者的主要不良心脏事件发生率;评价糖尿病亚组及各种类型病变(包括左主干病变、分叉病变、慢性闭塞病变、钙化病变、开口病变、小血管病变、急性闭塞病变及再狭窄病变)的治疗效果。结果　2 6 3例患者支架置入成功率为1 0 0 % ;随访2 4 6例,失访1 7例,随访率93 5% ;主要不良心脏事件有1 0例,发生率为3 8% ;复查冠状动脉造影1 39例,支架内再狭窄率为1 0 1 % ,其中糖尿病亚组为1 2 . 9% ,弥漫病变为1 0 . 0 % ,开口病变6 9% ,慢性闭塞病变1 1 . 1 % ,小血管病变1 1 . 3% ,急性闭塞病变0 ,钙化病变9 1 % ,A型病变8 7% ,左主干病变2 2 . 2 % ,分叉病变1 8 .8% ,再狭窄病变1 1 . 1 %。结论　在真实临床状态下,CypherTM 支架可以明显减少糖尿病患者弥漫病变,急、慢性闭塞病变,小血管病变,开口病变,钙化病变,A型病变等主要不良心脏事件的发生。对于左主干病变、分叉病变和再狭窄病变,提示有益的疗效,临床疗效需进一步观察。     

雷帕霉素和紫杉醇药物洗脱支架治疗冠状动脉开口病变的临床疗效比较

目的:评价雷帕霉素和紫杉醇两种药物洗脱支架治疗冠状动脉开口处病变的临床效果。方法:选择我院2004年4月12日至2006年04月30日期间连续于冠状动脉开口处置入雷帕霉素或紫杉醇药物洗脱支架,并在6个月后完成冠状动脉造影随访的92例(95个病变)患者进入该研究。分成紫杉醇药物洗脱支架组(紫杉醇组,美国Boston公司Taxus支架)45例(47个病变)和雷帕霉素药物洗脱支架组(雷帕霉素组,美国Cordis公司Cypher支架)47例(48个病变)。对两组患者的主要心脏不良事件包括死亡、心肌梗死及靶病变血运重建率进行比较。结果:紫杉醇组47处病变共置入47个支架,雷帕霉素组48处病变共置入49个支架,两组手术成功率均100%。定量冠状动脉造影显示紫杉醇组和雷帕霉素组术前参考血管直径分别为(2.85±0.53)mm和(2.96±0.41)mm,病变长度为(15.7±14.1)mm和(18.1±11.6)mm;术后支架总长度为(19.68±14.26)mm和(23.87±12.17)mm,最大扩张压力为(14.2±2.9)atm和(15.0±2.7)atm,两组比较均没有差异。术后30天随访无主要心脏不良事件发生,无急性和亚急性血栓形成。6个月随访时雷帕霉素组和紫杉醇组的主要心脏不良事件分别为6.4%和11.1%,没有显著差异(P=0.184)。两组平均造影随访时间相似〔(225±84)天vs(210±50)天〕。紫杉醇组的节段内和支架内再狭窄率分别为22.2%(10/45)和15.5%(7/45),雷帕霉素组为4.3%(2/47)和0%(0/47),两组比较有显著差异(P<0.01);边缘再狭窄率分别为6.7%(3/45)和4.3%(2/47),两组无差异(P>0.05)。紫杉醇组6个月后的靶病变血运重建率8.9%,雷帕霉素组4.3%,无显著差异(P>0.05)。紫杉醇组的支架内和节段内的晚期管腔丢失〔(0.65±0.67)mm,(0.68±0.65)mm〕明显高于雷帕霉素组〔(0.16±0.18)mm,(0.15±0.24)mm(P<0.001)〕。结论:两种药物洗脱支架治疗冠状动脉开口病变均安全有效。雷帕霉素支架的造影再狭窄率和晚期管腔丢失明显低于紫杉醇支架,但两种药物洗脱支架6个月后的靶病变血运重建没有显著差异。     

雷帕霉素洗脱支架预防再狭窄23例的临床观察

目的:观察雷帕霉素洗脱支架对减少再狭窄的效果及安全性。方法:对入选的23例患者应用球囊预扩张后置入雷帕霉素支架,术后1、3、6个月进行临床随访,术后6个月造影随访。结果:23例患者25只支架全部置入成功。术后6个月发生重要心脏不良事件、靶血管失败、支架内血栓形成及穿刺处血管并发症各1例。术后6个月23例患者中18例进行了造影复查,仅1例(5.6%)发生支架内再狭窄,病变血管为前降支,狭窄程度为50%。结论:应用雷帕霉素洗脱支架进行冠状动脉介入治疗有效、安全。     

国产与进口药物洗脱支架治疗冠心病合并糖尿病患者的安全性和有效性

目的 观察国产雷帕霉素药物洗脱支架(Partner)在冠心病合并糖尿病患者中应用的安全性和有效性.方法 选择269例冠心病合并糖尿病患者置入雷帕霉素药物涂层支架,其中Partner组135例患者置入国产雷帕霉素药物洗脱支架(Partner支架),134例患者置入Cypher支架(Cypher组),术前术后常规用药,术后进行随访,观察患者临床主要不良心脏事件的发生情况,部分患者进行了冠状动脉造影随访.结果 269例患者共置入447枚支架,分析表明C型病变、双支、三支病变为多,两组患者一般临床情况差异无统计学意义.两组靶病变部位、病变长度、狭窄程度及病变类型差异均无统计学意义.其中Partner组置入支架229枚,Cypher组218枚.平均随访(360±50)d,其中Partner组复发心绞痛13例(9.6％),1例发生心肌梗死(0.7％);Cypher组复发心绞痛11例(8.2％),无心肌梗死发生(0.0％),Partner组发生再狭窄2例(1.5％),Cypher组发生再狭窄2例(1.5％).两组无支架内血栓形成和死亡.结论 对比Cypher支架,使用Partner支架在冠心病合并糖尿病患者中应用安全有效,在降低主要心脏不良事件预防再狭窄获得满意的临床效果.     

雷帕霉素洗脱支架治疗冠状动脉慢性完全性闭塞病变

目的:评价雷帕霉素洗脱支架在冠状动脉慢性(闭塞时间≥3个月)闭塞性病变治疗中的疗效。方法:86例冠状动脉造影显示慢性闭塞性病变患者,在成功重建冠状动脉血运后置入雷帕霉素洗脱支架(CypherTM, Cordis,Johnson & Johnson)50例(SES组),裸金属支架36例(BMS组),比较两组术后1年内各种不良心脏事件(死亡、心肌梗死、再次血管重建术和支架内血栓形成)的发生情况和再狭窄、再闭塞发生率。结果:SES组不良心脏事件发生率较BMS组显著降低(4．0％vs 19．4％,P<0．05)。SES组和BMS组分别有17例 (34．0％)和13例(36．1％)患者行冠状动脉造影复查,SES组较BMS组晚期丧失[(0．18±0．54)mm vs(0．85±0．98) mm,P<0．05]和再狭窄率(11．8％ vs 46．2％,P<0．05)显著降低。结论:雷帕霉素洗脱支架在冠状动脉慢性闭塞性病变治疗中可显著降低不良心脏事件的发生率和再狭窄发生率。     

国产及进口药物涂层支架治疗无保护左主干病变的疗效观察

选择经冠状动脉造影证实无保护左主干病变患者48例,随机分成进口雷帕霉素洗脱支架（Cypher支架）和国产雷帕霉素洗脱支架（Firebird支架）两组,比较两种支架的疗效.临床随访6～9个月,两组心脏主要不良心脏事件、支架内再狭窄率、支架内最小管腔直径（MLD）、节段内MLD、支架内晚期管腔丢失（LLL）、节段内LLL均无统计学意义.认为国产和进口雷帕霉素药洗脱支架在无保护左主干病变中的近期疗效相似.     

Mid-Term Clinical Outcomes of ACS and Non-ACS Patients Treated With Everolimus-Eluting Stents

Drug-eluting stents (DES) have proven to be effective for reducing the rate of restenosis, whereas stent thrombosis (ST) after DES implantation has raised safety concerns. Everolimus-eluting stents (EES) are a new generation of DES that have demonstrated safety and efficacy compared with first-generation DES. However, the use of EES in patients presenting with acute coronary syndrome (ACS) has not been adequately investigated. We compared the clinical outcomes between the ACS and non-ACS groups treated with EES. A total of 335 consecutive patients who received EES implantation between January 2010 and January 2011 were investigated (ACS; n = 172, non-ACS; n = 163). Clinical outcome data were obtained for 94.3% of the patients. Follow-up angiography was performed in 58.5% of all patients. The median follow-up period was 8 months in both groups. Clinical outcomes were not statistically different between the groups. The rate of target lesion revascularization (TLR) was 2.5% in the ACS group and 3.8% in the non-ACS group (P = 0.37). MACE occurred in 8.2% of the ACS group and 10.2% of the non-ACS group (P = 0.54). A definite ST was identified in one patient in each group (P = 0.75). The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant difference between the groups for TLR, target vessel revascularization (TVR), all-cause death, or MACE. In conclusion, EES was safe and efficacious for patients presenting with ACS, as well as for those with non-ACS during a mid-term follow-up period.     

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。     

Sirolimus-versus paclitaxel-eluting stents: a comparison of two consecutive series in routine clinical practice

BACKGROUND: We compared two consecutive series of patients treated with sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES). METHODS: Two hundred and ninety-five patients with 590 coronary lesions were treated with 274 SES and 379 PES. Patients with symptoms or positive dobutamine stress echocardiography were subjected to repeat coronary angiography. RESULTS: During a follow-up of 13.3 +/- 5.7 months, the incidence rate of major adverse cardiac events (MACE) was 4.1%, including, 1 death, 4 Q-wave myocardial infarctions, 2 late angiographic stent thromboses, 3 subacute stent thromboses, and 11 target vessel revascularizations (TVR), and was not significantly different between SES (n = 5) and PES (n = 7).Stent overlapping was found to be an independent predictor of both MACE (odds ratio = 0.078, P = 0.02) and TVR (odds ratio = 0.077, P = 0.02). Follow-up symptoms- or ischemia-driven angiography was performed in 45 patients. Only vessel size was a predictor of stent restenosis (P = 0.02), independent of stent type. Late loss was independently predicted by postdilatation of stent (beta =-0.24, P = 0.03), but not by type of stent (P = 0.14) or other parameters. Edge restenosis was seen in 8 patients subjected to lesion predilatation. The restenosis pattern after SES implantation was focal, but diffuse (n = 1) or proliferative (n = 1) restenosis, and in-stent aneurysm formation (n = 1) was also seen with PES. CONCLUSIONS: Despite a trend for a higher incidence of MACE with PES, no significant differences between the two stent types were detected. Diffuse restenosis was seen only with PES, and edge restenosis only in lesions with balloon predilatation before stent implantation. Stent overlapping was an independent predictor of both TVR and MACE.     

冠状动脉支架置入术后不同类型支架再狭窄形式分析

目的通过分析冠状动脉支架置入后造影复查的影像资料,寻找不同支架再狭窄的特点。方法入选行冠状动脉病变介入治疗后造影复查的846处病变,对再狭窄病变行再狭窄形式分析。结果裸支架和药物支架再狭窄中支架近端局限性再狭窄分别占5.69%和33.67%(P=0.000),而支架内弥漫性再狭窄分别占29.27%和9.18%(P=0.000),弥漫性狭窄累及支架两端的分别为20.33%和6.12%(P=0.003),闭塞性再狭窄发生率分别为9.76%和10.20%(P=0.912)。雷帕霉素及其衍生物释放支架和紫杉醇释放支架再狭窄支架边缘局限性再狭窄分别为47.06%和25.00%(P=0.037),支架内弥漫性狭窄分别为1.96%和16.67%(P=0.018)。结论药物支架改变了支架再狭窄模式,弥漫型转为局限型;闭塞性再狭窄时药物支架以支架近端闭塞为主,裸支架以支架内闭塞为主;紫杉醇药物释放支架弥漫性再狭窄发生率较雷帕霉素释放支架有所增加。     

Vascular brachytherapy for patients with drug-eluting stent restenosis

Background: The rate of drug‐eluting stent (DES) in‐stent restenosis (ISR) exceeds 10% in complex subsets of patients and lesions. The optimal management of DES ISR remains undetermined. Vascular brachytherapy (VBT) is proven to be effective for the treatment of bare metal stent ISR but its outcome for DES ISR has not been established. Methods: Ninety‐nine consecutive patients who presented with ISR following DES implantation in 122 lesions were subjected to conventional percutaneous coronary intervention with adjunct VBT using either beta radiation (Beta Rail in 74 patients [82.2%] and the Galileo system in 13 patients [14.4%]) or gamma radiation (Checkmate system in 3 patients [3.3%]). Patients were followed clinically for major adverse cardiac events (MACE) during 1‐year follow‐up. Results: A high proportion of patients in this cohort presented with complex ISR; 31.1% had recurrences of ISR to the same site, 55% had diffuse or proliferate pattern of restenosis, and 23 lesions (18.9%) were located in a saphenous vein graft. Procedural success and uneventful in‐hospital course were documented in all patients post VBT. At 12 months' follow‐up, the target lesion revascularization (TLR) rate was 11% and the overall MACE rate was 26%. Patients with multiple episodes of ISR to the same site had a TLR of 16% and MACE rate of 35.5%. Conclusions: VBT for the treatment of DES ISR was found to be effective and safe and should be considered for the treatment of DES ISR, in particular in complex patients with multiple recurrences.     

药物洗脱支架和金属裸支架治疗弥漫病变的比较研究

目的比较冠心病患者弥漫病变采用药物洗脱支架和金属裸支架治疗的近期和远期预后,分析影响这类病变介入治疗预后的危险因素。方法研究对象为我院2004年4月至2005年8月接受置入单个长度>25.0mm支架治疗并且进行冠状动脉造影随访的205例患者,排除支架置入失败及支架置入位置不理想者。分为置入药物洗脱支架(DES)组(n=128)和置入金属裸支架(BMS)组(n=77)。所有的患者术后均接受阿司匹林300mg、氯吡格雷75mg等规范药物治疗。手术成功判定标准为至少用相互垂直的两个投照体位行冠状动脉造影,肉眼判定残余狭窄<20%和前向血流TIMI3级。再狭窄判定标准以复查冠状动脉造影定量分析支架内或支架邻近血管管腔直径狭窄程度≥50%。患者在支架术后6个月左右接受冠状动脉造影随访。结果共205例患者(男性181例,女性24例)227个靶病变置入382枚支架完成造影随访。其中C型病变占总数的93.8%,B2型病变为6.2%。双支或双支以上血管病变的患者比例达到86.8%。平均术前参考血管直径(2.88±0.43)mm。平均每个病变支架长度(40.09±12.94)mm,54.2%的病变接受了重叠置入支架。比较置入DES组和置入BMS组,两组的患者基本条件差异无统计学意义,在病变基本条件方面,DES组术前参考血管直径明显小于BMS组[(2.80±0.37)mm比(3.10±0.48)mm,P=0.005]。6个月随访结果显示再狭窄率DES组(15.4%)小于BMS组(48.4%),P<0.001。晚期支架内腔径丢失BMS组明显大于DES组[(0.94±0.76)mm比(0.39±0.53)mm,P<0.001]。靶病变血管重建率DES要明显好于BMS(11.6%比38.5%,P<0.001)。支架内再狭窄在置入DES组的局限性再狭窄比例大于置入BMS组(33.3%比18.2%,P=0.029)。对影响复杂弥漫病变支架再狭窄因素的多元logistic回归分析发现,采用支架重叠置入(OR=2.82,P=0.017)和支架类型(OR=5.71,P<0.001)是对复杂弥漫病变支架内再狭窄影响最大的危险因素。结论我们的研究发现对于复杂弥漫病变的治疗,药物洗脱支架有着良好的治疗效果,较金属裸支架能明显减低再狭窄率。对于弥漫病变,我们应该使用长支架,尽可能减少支架重叠置入的数量。     

Incidence and predictors of recurrent restenosis following implantation of drug-eluting stents for in-stent restenosis.

OBJECTIVES: We investigated the incidence and predictors of recurrent restenosis after drug-eluting stent (DES) implantation for in-stent restenosis (ISR) in routine clinical practice. BACKGROUND: Although DESs have been increasingly used for treatment of ISR, little is known about the predictors of DES failure. METHODS: We determined the incidence of recurrent restenosis and major adverse cardiac events (MACE) in 224 consecutive patients with 239 lesions treated with sirolimus-eluting (n=217 lesions) or paclitaxel-eluting (n=22 lesions) stents for the first episode of ISR. RESULTS: The procedural success rate was 99.2%, and in-hospital complications did not occur in any patient. Follow-up angiography at 6 months was obtained in 73.7% of patients. Angiographic re-restenosis rate was 12.6%, and target lesion revascularization was required in 7.6% of patients. Of the 22 incidents of re-restenosis, 15 were focal (68.2%), 5 were diffuse (22.7%), and 2 were total (9.1%) restenosis. Univariate analysis showed that lesion length, use of paclitaxel-eluting stent, and number of stents per lesion were significant predictors of re-restenosis. In multivariate analysis, however, lesion length and use of paclitaxel-eluting stent were independent predictors of re-restenosis. During the follow-up (mean, 18.3+/-8.1 months), there were 4 deaths (1 cardiac, 3 noncardiac), but no nonfatal myocardial infarctions (MIs). MACE occurred in 18 patients. The cumulative probability of MACE-free survival was 92.9+/-1.8% at 1 year and 90.5+/-2.4% at 2 years. CONCLUSIONS: DESs are highly effective for treatment of ISR, with recurrent restenosis related to lesion length and type of DES.     

Sirolimus, Tacrolimus and Zotarolimus eluting stents to treat bifurcated lesions: a 7-month clinical outcome comparison

AIM: Drug eluting stents (DES) have been shown to reduce restenosis compared with bare metal stents in bifurcated lesions. The aim of this study was to evaluate the long-term clinical outcomes of patients with bifurcated lesions treated by 3 different DES. METHODS: Consecutive patients with symptomatic coronary artery disease on one bifurcated lesion with SB>2.25 mm (on visual estimation) undergoing at the Department of Cardiology of the Catholic University of Rome, Italy were screened. Patients treated with Sirolimus-eluting stent (Cypher Select; SES Group), Tacrolimus-eluting stent (Taxus-Libertè; TA Group) and Zotarolimus-eluting stent (Endeavor Driver; ZOT Group) were enrolled in the study. Clinical and angiographic characteristics of all patients were prospectively recorded. Major adverse clinical events (MACE), including death, acute myocardial infarction (MI) or target lesion revascularization (TVR) by either percutaneous coronary intervention (PCI) or coronary surgery were recorded during the follow-up. Incidence of definite or probable stent thrombosis was calculated according to the ARC criteria. RESULTS: Two hundred and forty-one consecutive patients were enrolled (89 Group CY, 98 Group TA and 54 Group EN). Length of follow-up was 235+/-60 days. Baseline clinical and angiographic characteristic were similar across the groups. The adopted technique for stent implantation was provisional stenting (73.4%), T-stenting technique (7%), crush (7%) and V-stenting (2.6%). The rate of patients finally treated with two stents was similar among groups. The cumulative rate of MACE (9% SES, 12% TA, 11% ZOT: P=0.7) and of TVR (2% SES, 9% TA, 7% ZOT) was similar among groups. No definite stent thrombosis was observed during follow-up, while 1 probable stent thrombosis was observed in TA group. CONCLUSION: The clinical outcome of bifurcated lesions using DES and mainly a technique of single stent implantation is good. In the present observational study, clinical adverse events did not differ in patients with bifurcated lesions treated by Cypher, Taxus or Endeavor stent implantation.     

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。