药物洗脱性支架和裸金属支架植入治疗冠状动脉狭窄的临床随访观察

目的探讨药物洗脱性支架(DES)和裸金属支架(BMS)治疗冠状动脉狭窄的远期疗效。方法对成功进行DES植入术患者2734例和BMS植入患者216例术后6个月、1年进行随访,观察其支架内再狭窄(ISR)发生率、急性心肌梗死发生率、冠状动脉旁路移植(CABG)或再次经皮冠状动脉介入治疗(PCI)治疗率、病死率,分析术后再狭窄的独立危险因素。结果术后6个月、1年时DES组ISR发生率均低于BMS组(9.58%vs 18.98%,18.32%vs 31.94%),差异有统计学意义(P<0.05);随访6个月时,急性心肌梗死发生率、CABG或再次PCI治疗率和病死率方面比较差异无统计学意义(P>0.05),但是随访1年后,其差异有统计学意义(P<0.05);多因素分析发现,支架直径≤3 mm、吸烟和年龄是支架植入术后发生再狭窄的独立危险因素。结论在冠状动脉狭窄的治疗中,DES的远期疗效优于BMS,但临床应用还需要进一步的循证医学研究证据。

Clinical follow up observation of drug eluting stent and bare metal stent for coronary heart disease

Objective To evaluate the long term clinical affection of drug eluting stent（DES） and bare metal stent （ISR）for coronary heart disease.Methods 2950 patients with coronary heart disease was treated by DES（n = 2734） or BMT（n =216）.The incidence of ISR,acute myocardial infarction,PCI/CABG and mortality were observed and analyzed.Results More patients receiving BMS experienced ISR compared with patients receiving DES（9.58%vs.18.98%,18.32% vs.31.94%,P 0.05）;there were no significant difference between patients who treated with BMS and DES in acute myocardial infarction,PCI/CABG and mortality at half one years（P 0.05）,but more patients receiving BMS compared with patients receiving DES in one years follow up（P 0.05）.Stent diameter≤3 mm,age and smoking are the independent risk factors for the ISR.Conclusion The long term clinical effecting of drug eluting stent was superior than bare metal stent,meta -analysis were needed for further proving this conclusion.