CAJ | 학술논문

混合置入药物洗脱支架和裸金属支架治疗多处冠状动脉病变的远期疗效和安全性评价
혼합치입약물세탈지가화라금속지가치료다처관상동맥병변적원기료효화안전성평개
Evaluation of Long-term Efficacy and Safety for Hybrid Stent and Exclusive Drug Eluting Stent Implantation for Treating the Patients With Multi-lesion Coronary Disease

万方数据

中国循环杂志中國循環雜誌 중국순배잡지
CHINESE CIRCULATION JOURNAL
2014年 7期 492-496 ,共5页

李一平%张冬%窦克非%徐波%杨跃进%陈珏%刘海波%姚民%秦学文%吴永健%李建军%乔树宾%尤士杰%陈纪林%高润霖

리일평%장동%두극비%서파%양약진%진각%류해파%요민%진학문%오영건%리건군%교수빈%우사걸%진기림%고윤림

药物洗脱支架%裸金属支架%有效性%安全性藥物洗脫支架%裸金屬支架%有效性%安全性
약물세탈지가%라금속지가%유효성%안전성
Drug Eluting stent%Bare Metal stent%Efifcacy%Safety

目的：评估混合置入药物洗脱支架和裸金属支架治疗多处冠状动脉病变的远期疗效和安全性。 　　方法：本研究入选我院于2004-04至2006-10行择期经皮冠状动脉介入治疗的冠状动脉多处病变患者6495例，并根据支架置入种类分为混合置入药物洗脱支架和裸金属支架组（Hybrid支架组，n=848）和单纯药物洗脱支架组（n=5647）。按1：1的比例进行倾向性评分匹配后，共823对患者最终纳入研究。临床随访资料包括术后一年及两年的全因死亡、心肌梗死、靶病变血运重建、靶血管血运重建、主要心脏不良事件和支架内血栓形成。本研究比较了经倾向性评分匹配后的两组术后一年及两年的各种临床事件的累积发生率，并通过COX比例风险模型对临床事件风险进行了评估。 　　结果：经过倾向性评分匹配后COX比例风险模型分析显示，Hybrid支架组的靶病变血运重建（风险比2.38，95％可信区间1.50~3.70）、靶血管血运重建（风险比1.61，95％可信区间1.15~2.27）以及主要心脏不良事件（风险比1.37，95％可信区间1.02~1.85）风险显著高于单纯药物洗脱支架组（P均<0.01），差异有统计学意义。两组间一年及两年的全因死亡、心肌梗死和全因死亡/心肌梗死累积发生率差异无统计学意义（P均>0.05）。 　　结论：对于冠状动脉多处病变需置入多枚支架的患者而言，混合置入药物洗脱支架和裸金属支架具有更高的靶病变血运重建、靶血管血运重建及主要心脏不良事件的风险，其远期疗效劣于单纯药物洗脱支架，但两种支架置入策略的安全性相当。
목적：평고혼합치입약물세탈지가화라금속지가치료다처관상동맥병변적원기료효화안전성。 　　방법：본연구입선아원우2004-04지2006-10행택기경피관상동맥개입치료적관상동맥다처병변환자6495례，병근거지가치입충류분위혼합치입약물세탈지가화라금속지가조（Hybrid지가조，n=848）화단순약물세탈지가조（n=5647）。안1：1적비례진행경향성평분필배후，공823대환자최종납입연구。림상수방자료포괄술후일년급량년적전인사망、심기경사、파병변혈운중건、파혈관혈운중건、주요심장불량사건화지가내혈전형성。본연구비교료경경향성평분필배후적량조술후일년급량년적각충림상사건적루적발생솔，병통과COX비례풍험모형대림상사건풍험진행료평고。 　　결과：경과경향성평분필배후COX비례풍험모형분석현시，Hybrid지가조적파병변혈운중건（풍험비2.38，95％가신구간1.50~3.70）、파혈관혈운중건（풍험비1.61，95％가신구간1.15~2.27）이급주요심장불량사건（풍험비1.37，95％가신구간1.02~1.85）풍험현저고우단순약물세탈지가조（P균<0.01），차이유통계학의의。량조간일년급량년적전인사망、심기경사화전인사망/심기경사루적발생솔차이무통계학의의（P균>0.05）。 　　결론：대우관상동맥다처병변수치입다매지가적환자이언，혼합치입약물세탈지가화라금속지가구유경고적파병변혈운중건、파혈관혈운중건급주요심장불량사건적풍험，기원기료효렬우단순약물세탈지가，단량충지가치입책략적안전성상당。
Objective: To evaluate the hybrid of drug eluting stent (DES) with bare metal stent (BMS) and exclusive DES implantation for treating the patients with multi-lesion coronary disease. Methods: A total of 6495 patients with multi-lesion coronary disease received elective PCI in our hospital from 2004-04 to 2006-10 were retrospectively studied. The patients were divided into 2 groups, Hybrid group, n=848 and Exclusive DES group, n=5647. With 1:1 propensity score matching, there were 823 pair of patients were ifnally studied. The clinical outcomes included 1, 2 years post-operative all cause death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), major adverse cardiac events (MACE) and in-stent thrombosis. The relative risks of all outcomes were assessed by Cox’s proportional-hazard model after propensity match. Results: With propensity match, Cox’s proportional-hazard model analysis indicated that compared with Exclusive DES group, Hybrid group had the higher risks of TLR (HR 2.38, 95%CI 1.50-3.70), TVR (HR 1.61, 95%CI 1.15-2.27), MACE (HR 1.37, 95%CI 1.02-1.85), all P<0.01. The all cause death, MI and the ratio of all cause death/MI were similar between 2 groups in 1, 2 years follow-up period, all P>0.05. Conclusion:Compared with exclusive DES, the hybrid of DES with BMS implantation had the higher risk of TLR, TVR and MACE for treating the patients with multi-lesion coronary disease.