小血管病变对涂层可降解药物洗脱支架置入冠心病患者预后影响
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摘要
目的探讨置入涂层生物可降解雷帕霉素洗脱支架(BP-SES)的冠心病(CAD)患者合并小血管病变对其长期临床预后的影响。方法选取I-LOVE-IT 2研究中置入BP-SES的CAD患者1 829例为研究对象。根据是否合并小血管病变分为小血管组(参考血管直径≤2.75 mm,n=1 064)与非小血管组(参考血管直径>2.75 mm,n=765)。所有患者均获得4年随访,分析其临床疗效及预后情况。结果小血管组患者4年患者源性的复合终点(PoCE)的发生率显著高于非小血管组,两组间比较,差异有统计学意义(P<0.05)。小血管组患者心性死亡的发生率高于非小血管组,两组间比较,差异有统计学意义(P<0.05)。多因素分析表明,小血管病变为PoCE的独立危险因素(风险比=1.24,95%可信区间1.00～1.53,P<0.05)。结论对于置入BP-SES的CAD患者,合并小血管病变的患者远期预后较差,小血管病变是4年PoCE的独立的危险因素。
Objective To investigate the effect of implantation of biodegradable polymer-coated cobalt-chromium sirolimus-eluting stent(BP-SES)on long-term clinical prognosis of coronary artery disease(CAD)patients with small vessel lesions.Methods There were 1 829 CAD patients implanted with BP-SES in the I-LOVE-IT 2 study were selected as subjects.The patients were divided into the small vessel group(reference vessel diameter less than 2.75 mm,n=1 064)and non-small vessel group(reference vessel diameter more than 2.75 mm,n=765)according to the presence or absence of small vessel lesions.All patients were followed up for 4 years to analyze their clinical efficacy and prognosis.Results The 4-year follow-up results revealed that the incidence of patient-oriented composite endpoint(PoCE)in small vessel group were significantly higher than patients with non-small vessel group,and the difference between the two groups was statistically significant(P<0.05).In addition,the incidience of cardiac death in the small vessel group was higher than that in the non-small vessel group(P<0.05).Multivariate analysis showed that small vessel was an independent predictor of PoCE(hazard ratio=1.24,95% confidence interval 1.00-1.53,P<0.05).Conclusion For CAD patients with BP-SES implantation,the long-term prognosis of patients with small vascular lesions is poor,and small vascular lesions are independent risk factors for 4-year PoCE.
Objective To investigate the effect of implantation of biodegradable polymer-coated cobalt-chromium sirolimus-eluting stent(BP-SES)on long-term clinical prognosis of coronary artery disease(CAD)patients with small vessel lesions.Methods There were 1 829 CAD patients implanted with BP-SES in the I-LOVE-IT 2 study were selected as subjects.The patients were divided into the small vessel group(reference vessel diameter less than 2.75 mm,n=1 064)and non-small vessel group(reference vessel diameter more than 2.75 mm,n=765)according to the presence or absence of small vessel lesions.All patients were followed up for 4 years to analyze their clinical efficacy and prognosis.Results The 4-year follow-up results revealed that the incidence of patient-oriented composite endpoint(PoCE)in small vessel group were significantly higher than patients with non-small vessel group,and the difference between the two groups was statistically significant(P<0.05).In addition,the incidience of cardiac death in the small vessel group was higher than that in the non-small vessel group(P<0.05).Multivariate analysis showed that small vessel was an independent predictor of PoCE(hazard ratio=1.24,95% confidence interval 1.00-1.53,P<0.05).Conclusion For CAD patients with BP-SES implantation,the long-term prognosis of patients with small vascular lesions is poor,and small vascular lesions are independent risk factors for 4-year PoCE.
引文
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[14] Van Belle E,Perie M,Braune D,et al.Effects of coronary stenting on vessel patencyand long-term clinical outcome after percutaneous coronary revascularization in diabetic patients[J].J Am Coll Cardiol,2002,40(3):410.
[15] Hachamovitch R,Hayes SW,Friedman JD,et al.Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography[J].Circulation,2003,107(23):2900-2907.
[2] Foley DP,Melkert R,Serruys PW.Influence of coronary vessel size on renarrowing process and late angiographic outcome aftersuccessful balloon angioplasty[J].Circulation,1994,90(3):1239-1251.
[3] Alfonso F,Garcia-Guimaraes M.Optimal coronary interventions in small vessels:is size all that matters[J].JACC Cardiovasc Interv,2016,9(13):1335-1337.
[4] Elezi S,Kastrati A,Neumann FJ,et al.Vessel size and long-term outcome after coronary stent placement[J].Circulation,1998,98(18):1875-1880.
[5] Ardissino D,Cavallini C,Bramucci E,et al.Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries:a randomized trial[J].JAMA,2004,292(22):2727-2734.
[6] Han Y,Xu B,Jing Q,et al.A randomized comparison of novel biodegradable polymer-and durable polymer-coated cobalt-chromium sirolimus-eluting stents[J].JACC Cardiovasc Interv,2014,7(12):1352-1360.
[7] Han Y,Xu B,Xu K,et al.Six versus 12 months of dual antiplatelet therapy after implantation of biodegradable polymer sirolimus-eluting stent:randomized substudy of the I-LOVE-IT 2 trial[J].Circ Cardiovasc Interv,2015,66(15):38-38.
[8] Puymirat E,Peace A,Mangiacapra F,et al.Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary revascularization in patients with small-vessel disease[J].Circ Cardiovasc Interv,2012,5(1):62-68.
[9] Brunner-LaRocca HP,Kaiser C,Pfisterer M,et al.Targeted stent use inclinical practice based on evidence from the Basel Stent Cost Effectiveness Trial (BASKET)[J].Eur Heart J,2007,28(6):719-725.
[10] Puymirat E,Mangiacapra F,Peace A,et al.Long-term clinical outcome in patients with small vessel disease treated with drug-eluting versus bare-metal stenting[J].Circ Cardiovasc Interv,2012,15(1):62-68.
[11] Ellis SG,Popma JJ,Lasala JM,et al.Relationship between angiographic late loss and target lesion revascularization after coronary stent implantation:analysis from the TAXUS-IV trial[J].J Am Coll Cardiol,2005,45(8):1193-1200.
[12] Cassese S,Byrne RA,Tada T,et al.Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography[J].Heart,2014,100(2):153-159.
[13] Pursnani S,Korley F,Gopaul R,et al.Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease:a systematic review and meta-analysis of randomized clinical trials[J].Circ Cardiovasc Interv,2012,5(4):476-490.
[14] Van Belle E,Perie M,Braune D,et al.Effects of coronary stenting on vessel patencyand long-term clinical outcome after percutaneous coronary revascularization in diabetic patients[J].J Am Coll Cardiol,2002,40(3):410.
[15] Hachamovitch R,Hayes SW,Friedman JD,et al.Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography[J].Circulation,2003,107(23):2900-2907.