Incidence and predictors of target lesion failure in patients undergoing contemporary DES implantation-Individual patient data pooled analysis from 6 randomized controlled trials
Incidence and predictors of target lesion failure in patients undergoing contemporary DES implantation-Individual patient data pooled analysis from 6 randomized controlled trials
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DOI：
10.1016/j.ahj.2019.03.011
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发表时间：
2019-07-01
影响因子：
4.8
通讯作者：
Ali, Ziad A.
中科院分区：
文献类型：
--
作者：
Konigstein, Maayan;Madhavan, Mahesh, V;Ali, Ziad A.
背景药物洗脱支架（DES）改善了接受经皮冠状动脉介入治疗（PCI）患者的临床结局。尽管如此，仍会发生与既往治疗病变相关的不良事件。我们试图评估当代DES implantation.Methods患者的靶病变失败（TLF）的发病率和预测因素，从6个前瞻性，随机试验的患者水平的数据进行汇总，DES治疗结果进行了分析，在长达5年。主要结局为TLF（心源性死亡、靶病变血运重建或靶血管心肌梗死）。考克斯比例风险模型用于识别TLF的预测因子。30天、1年和5年时的TLF率分别为1.7%、4.3%和11.9%。30天时TLF的唯一独立预测因素是支架长度（风险比[ HR] 1.017，95%CI 1.011-1.024，P <0.0001）。中度/重度钙化、支架长度和术后直径硬化是30天至1年的预测因素，但不是1至5年的预测因素。参考血管直径是5年时唯一的病变相关预测因素（P =.003）。30天至1年TLF的临床预测因素为糖尿病和高血压（两者P <0.01），1至5岁，糖尿病（HR 1.40，95% CI 1.13-1.73，P =.002），既往冠状动脉旁路移植术（HR 2.52，95% CI 1.92-3.30，P <0.0001）和既往PCI（HR 1.29，95% CI 1.02-1.64，P = 0.04）预测TLF。参考血管直径是长期TLF的唯一病变相关预测因素;临床预测因素为糖尿病、既往冠状动脉旁路移植术和既往PCI。
Background Drug-eluting stents (DESs) have improved clinical outcomes of patients undergoing percutaneous coronary intervention (PCI). Nevertheless, adverse events related to previously treated lesion still occur. We sought to evaluate the incidence and predictors of target lesion failure (TLF) in patients undergoing contemporary DES implantation.Methods Patient-level data from 6 prospective, randomized trials were pooled, and DES treatment outcomes were analyzed at up to 5 years. Primary outcome was TLF (cardiac death, target lesion revascularization, or target vessel myocardial infarction). Cox proportional-hazards model was used to identify predictors of TLF.Results Overall, 10,072 patients were included in the analysis. TLF rate was 1.7%, 4.3%, and 11.9% at 30 days, 1 year, and 5 years, respectively. The only independent predictor of TLF at 30 days was stent length (hazard ratio [ HR] 1.017, 95% CI 1.011-1.024, P < .0001). Moderate/severe calcification, stent length and post procedural diameter sthenosis were predictors between 30 days to 1 year but not at 1 to 5 years. Reference vessel diameter was the only lesion-related predictor at 5 years (P =.003). Clinical predictors of TLF between 30 days and 1 year were diabetes and hypertension (P < .01 for both), and between 1 and 5 years, diabetes (HR 1.40, 95% CI 1.13-1.73, P =.002), prior coronary artery bypass grafting (HR 2.52, 95% CI 1.92-3.30, P < .0001), and prior PCI (HR 1.29, 95% CI 1.02-1.64, P =.04) predicted TLF.Conclusions Predictors of TLF vary in the early, late, and very late postprocedural periods. Reference vessel diameter was the only lesion-related predictor of long-term TLF; clinical predictors were diabetes, prior coronary artery bypass grafting, and prior PCI.