摘要
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�
Objective ： To evaluate the clinical efficacy and safety of two drug-eluting stents in the treatment of ostial lesions of coronary artery.
Methods ： From Apr. 2004 to Apr. 2006, 92 patients with 95 ostial lesions of coronary artery received drug-eluting stents. At 6 months after procedure angiographic follow-ups were performed, clinical and interventional data were analyzed. Patients were divided into paclitaxel-eluting stent group （PES group, n = 45, with 47 lesions） and rapamycin-eluting stents group（ SES group, n =47, with 48 lesions）. Baseline clinical characteristics in both groups were comparable. Quantitative coronary angiography （QCA） was performed for all patients. The major adverse cardiovascular events （MACE） , including deaths, myocardial infarction （MI） and target lesion revascularization（TLR） were compared.
Results： The number of ostial lesions of the two groups located at LM, RCA and LCX was the same, but the lesions involving LAD and total occlusion lesions were more common in SES group （ P 〈 0. 05 ）. Stents were implanted successfully in all patients. There was no MACE during 30-day follow-up in two groups. At 6-month follow-up, MACE was similar in both groups. Two patients （4. 3% ） in SES group and 4 （ 8.9% ） in PES group underwent TLR （ P 〉 0. 05 ）. Angiographic follow-up showed lower binary restenosis rates （4. 3% vs 22.2%, P 〈0. 01 ）, and smaller late loss （0. 16 ±0. 18 mm vs 0. 65±0. 67 mm, P 〈0. 001 ） in SES group.
Conclusions： The two types of drug-eluting stents for ostial lesions of coronary artery are effective and safe. Angiographic restenosis and late loss were lower in rapamycin-eluting coronary stents. TLR showed no significant difference between two types of drug-eluting coronary stents.
出处
《中国循环杂志》
CSCD
北大核心
2007年第5期326-328,共3页
Chinese Circulation Journal
关键词
开口病变
紫杉醇洗脱支架
雷帕霉素洗脱支架
Coronary ostial lesions
Paclitaxel-eluting stent
Rapamvcin-eluting stent
