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Comparison of the Efficacy of Drug-eluting Stents Versus Bare-metal Stents for the Treatment of Left Main Coronary Artery Disease

引用

Chinese Medical Journal 2015年第6期128卷 721-726页

作者： Xiao-ZengWang Kai Xu Yi Li Quan-Min Jing Hai-Wei Liu Xin Zhao Geng Wang Bin Wang Ying-Yan Ma Shao-Liang Chen Ya-Ling Han department of Cardiology General Hospital of Shenyang Military Region Shenyang Liaoning 110840 China department of cardiorogy Nanjing First Hospital Affiliated to Nanjing Medical University Nanjing Jiangsu 210006 China

treatment of left main coronary artery （LMCA） disease in select patients. However, it is unclear whether drug-eluting stents （DESs） have better outcomes in patients with LMCA disease compared with bare-metal stent （BMS） during long-term follow-up in Chinese populations. Methods： From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups： 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events （MACEs）, including cardiovascular （CV） death, myocardial infarction （MI）, and target lesion revascularization （TLR） at 5 years postimplantation. Results： Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE （19.4% vs. 31.8%, P = 0.022）, CV death （7.0% vs. 14.7%, P = 0.045）, and MI （5.4% vs. 12.4%, P = 0.049） than the BMS group. There were no significant differences in the rate of TLR （10.9% vs. 17.8%, P = 0.110） and stent thrombosis （4.7% vs. 3.9%, P = 0.758）. The rates of MACE （80.6% vs. 68.2%, P = 0.023）, CV death （93.0% vs. 85.3%, P - 0.045）, TLR （84.5% vs. 72.1%, P = 0.014）, and MI （89.9% vs. 80.6%, P = 0.029） free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and M1 were 0.41 （95% confidence interval [C/l： 0.21-0.63, P = 0.029） and 0.29 （95% CI： 0.08-0.92, P = 0.037）, respectively. Conelusions： DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.

关键词： Bare-metal Stent Drug-eluting Stent Left Main Coronary Artery Disease Percutaneous Coronary Intervention

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