冠状动脉旁路移植术后静脉移植血管内植入两代药物支架的临床结局比较

目的 比较冠状动脉旁路移植（CABG）术后患者静脉移植血管（SVG）病变内植入两代药物涂层支架（DES）的临床结局。方法 选取CABG术后因缺血症状行冠状动脉造影并在SVG内植入DES的患者共108例。其中第一代DES（涂层药物为西罗莫司）植入组69例，第二代DES（涂层药物为佐他莫司或依维莫司）植入组39例，对比2组患者介入治疗的效果和住院期间手术成功率及病死率。对比2组患者出院2年全因死亡、靶血管血运重建（TVR）和急性心肌梗死（AMI）等主要不良心脏事件（MACE）的发生情况。采用Kaplan-Meier法绘制生存曲线并比较2组患者无MACE生存率，并采用Cox回归分析SVG植入支架患者发生MACE的危险因素。结果 2组手术成功率、院内病死率差异无统计学意义。平均随访 2 年，共有 37 例发生 MACE，2 组 MACE 发生率差异无统计学意义（34.8% vs.33.3%，P＞0.05）。第二代组较第一代组TVR比例较低（2.6% vs. 13.0%，P＜0.05）。生存分析表明2组累积无MACE生存率差异无统计学意义（81.2% vs. 79.5%，Log-rank χ2=0.029，P＞0.05）。Cox 回归分析显示糖尿病（HR=2.530，95%CI：1.008～6.345，P=0.041）和支架直径（HR=1.143，95%CI：1.043～1.253，P=0.004）为 SVG 病变植入支架患者发生MACE的独立预测因子。结论 CABG后SVG内植入两代DES的院内病死率及2年随访MACE发生率相似，二代组TVR比例较低。合并糖尿病及植入大直径支架患者预后较差。

The comparison of clinical outcomes of the first and the second-generation drug-eluting stents implanted in vein grafts after coronary artery bypass graft

Objective To compare the clinical outcomes of the first and the second-generation drug-eluting stents (DES) implanted in saphenous vein grafts (SVG) in patients after coronary artery bypass graft (CABG). Methods A total of 108 patients with coronary angiography and DES implanting in SVG due to ischemia symptoms after CABG were collected in this study, including 69 patients with the first-generation of DES (drug-eluting: sirolimus) and 39 patients with the secondgeneration of DES (drug-eluting: zotarolimus or everolimus). The success rate of stents and mortality in hospital were compared between two groups of patients. The major adverse cardiac events (MACE), such as all-cause death, target vessel revascularization (TVR) and acute myocardial infarction (AMI) in 2-year follow-up were also compared between the two groups of patients. The survival curve was drawn by Kaplan-Meier method, and the MACE free survival rates of two groups of patients were compared. Cox regression analysis was used to evaluate the risk factors for MACE in patients with SVG stent implantation. Results There were no significant differences in the success rate of stents and mortality in hospital between the two groups. In average 2-year follow-up, a total of 37 cases of MACE were performed. There was no statistical difference in the incidence of MACE between the two groups (34.8% vs. 33.3%, P＞0.05). The proportion of TVR was significantly lower in the second-generation group than that of the first-generation group (13.0% vs. 2.6%, P＜0.05). Kaplan-Meier survival analysis showed that there were no statistically differences in the survival rates of no-cumulative events between the two groups (81.2% vs. 79.5%, Log-rank χ2=0.029, P＞0.05). COX regression analysis showed that diabetes (HR=2.530, 95%CI: 1.008-6.345, P=0.041) and stent diameter (HR=1.143, 95% CI: 1.043-1.253, P=0.004) were independent predictors for the MACE in patients implanted stents in SVG. Conclusion There are no significant differences in mortality in hospital and the MACE in 2-year follow-up between the patients of two generations of DES implanting in the SVG after coronary artery bypass grafting. The proportion of TVR is lower in the second-generation DES group. Patients with diabetes and large diameter stents have a poor prognosis.