Long-term clinical outcomes after drug-eluting and bare-metal stenting in Massachusetts.
Long-term clinical outcomes after drug-eluting and bare-metal stenting in Massachusetts.
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DOI：
10.1161/circulationaha.108.781377
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发表时间：
2008-10-28
期刊：
影响因子：
37.8
通讯作者：
Normand SL
中科院分区：
文献类型：
--
作者：
Mauri L;Silbaugh TS;Wolf RE;Zelevinsky K;Lovett A;Zhou Z;Resnic FS;Normand SL
药物洗脱支架（DES）减少了重复血运重建的需要，但其相对于裸金属支架（BMS）的长期安全性仍不确定。我们试图比较DES与BMS治疗患者的临床结局。从强制性州数据库中识别出2003年4月1日至2004年9月30日期间在马萨诸塞州非美国政府医院接受经皮冠状动脉介入治疗（PCI）和支架植入术的所有成人。根据首次入院时使用的支架类型对患者进行分类。前瞻性收集临床和手术风险因素。风险调整后的死亡率、心肌梗死和血运重建率差异（DES-BMS）通过倾向评分匹配（无置换）进行估计。11556例患者接受DES治疗，6237例患者接受BMS治疗，未校正的2年死亡率分别为7.0%和12.6%（p <0.0001）。在与5549例BMS患者匹配的5549例DES患者中，2年风险调整死亡率分别为9.8%和12.0%（p = 0.0002），心肌梗死分别为8.3%和10.3%（p = 0.0005），靶血管血运重建分别为11.0%和16.8%（p <0.0001）。在一项基于匹配人群的研究中，与BMS治疗相似的患者相比，DES治疗与较低的死亡率、心肌梗死和靶血管血运重建相关。需要对该纳入人群进行全面随访，以确定2年后是否仍保持相似的安全性和疗效。
Drug-eluting stents (DES) reduce the need for repeat revascularization, but their long term safety relative to bare metal stents (BMS) in general use remains uncertain. We sought to compare the clinical outcome of patients treated with DES vs. BMS. All adults undergoing percutaneous coronary intervention (PCI) with stenting between April 1, 2003 and September 30, 2004 at non-US governmental hospitals in Massachusetts were identified from a mandatory state database. Patients were classified according to stent types used from the index admission. Clinical and procedural risk factors were collected prospectively. Risk-adjusted mortality, myocardial infarction, and revascularization rate differences (DES-BMS) were estimated through propensity score matching without replacement. 11556 patients were treated with DES and 6237 treated with BMS with unadjusted 2 year mortality of 7.0% and 12.6% respectively (p<0.0001). In 5549 DES patients matched to 5549 BMS patients, 2 year risk-adjusted mortality rates were 9.8% and 12.0% (p=0.0002), myocardial infarction, 8.3% vs. 10.3% (p=0.0005), and target vessel revascularization, 11.0% vs. 16.8% (p<0.0001). DES treatment was associated with lower mortality, myocardial infarction, and target vessel revascularization compared with BMS treatment in similar patients in a matched population based study. Comprehensive follow-up in this inclusive population is warranted to identify if similar safety and efficacy remain beyond 2 years.