β-blockers reduce the incidence of clinical restenosis:: Prospective study of 4840 patients undergoing percutaneous coronary revascularization
β-blockers reduce the incidence of clinical restenosis:: Prospective study of 4840 patients undergoing percutaneous coronary revascularization
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DOI：
10.1016/s0002-8703(02)94726-5
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发表时间：
2003-05-01
影响因子：
4.8
通讯作者：
Anderson, JL
中科院分区：
文献类型：
--
作者：
Jackson, JD;Muhlestein, JB;Anderson, JL
背景经皮腔内冠状动脉介入治疗(PCI)后再狭窄仍是冠心病治疗的严重并发症。尽管β-肾上腺素能受体阻滞剂(BBS)有效地减少了许多心脏事件，但还没有大型前瞻性研究考察BBS与再狭窄的关系。方法我们前瞻性地评估了4840名接受支架置入术(60%)、球囊血管成形术(32%)或旋转性动脉粥样硬化切除术(8%)的患者，出院时开出的BBS与临床再狭窄的相关性。临床再狭窄定义为介入治疗后6个月内重复靶病变、血运重建或冠状动脉旁路移植术。其他终点包括9个月的临床再狭窄、重复靶点病变介入治疗(仅限)、长期(5年)靶点病变重复冠脉介入治疗和主要不良心脏事件(MACE)。结果患者的平均年龄为63岁，其中75%为男性，37%的患者服用BB处方。临床再狭窄的发生率为12%，且BB组的再狭窄发生率较低(BB组为10.0%，非BB组为13.5%，调整后优势比[OR]为0.76，P=0.004)。减少再狭窄的其他预测因素包括支架的使用、年龄和吸烟；增加再狭窄的预测因素包括糖尿病、动脉粥样硬化切除和接受治疗的血管数量。BBS还降低了9个月的临床再狭窄(10.3%vs 13.5%，OR 0.75，P=0.004)、MACE(16.5%vs 20.9%，OR 0.75，P<；6个月靶病变再狭窄(7.8%vs 10.2%，OR 0.75，P=.006)和5年靶病变再狭窄(12.0%vs 14.0%，OR 0.83，P=.046)。结论在4840例患者中，术后应用β受体阻滞剂可降低临床再狭窄、靶病变再狭窄和MACE的风险。β-受体阻滞剂对再狭窄的保护作用机制尚不清楚。
Background Restenosis after percutaneous transluminal coronary intervention (PCI) remains a serious complication in the treatment of coronary artery disease. Although beta-adrenergic receptor blockers (BBs) effectively reduce many cardiac events, no large prospective studies have examined the association of BBs with restenosis.Methods We prospectively evaluated the association of BBs (prescribed at hospital discharge) with clinical restenosis in 4840 patients who underwent stent placement (60%), balloon angioplasty (32%), or rotational atherectomy (8%). Clinical restenosis was defined as repeat target lesion revascularization or coronary artery bypass grafting within 6 months of PCI. Other end points included 9-month clinical restenosis, repeat target lesion PCI (only), long-term (5-year) target lesion repeat-PCI, and major adverse cardiac events (MACE). Multivariable regression adjusted the effect of BBs on clinical restenosis for 15 covariables.Results The average patient age was 63 years, 75% were men, and 37% received a BB prescription. The incidence of clinical restenosis was 12% overall and was lower among those prescribed a BB (10.0% for BB, 13.5% for none, adjusted odds ratio [OR] 0.76, P = .004). Other predictors of decreased restenosis included stent use, age, and smoking; predictors of increased restenosis included diabetes, atherectomy, and number of treated vessels. BBs also reduced 9-month clinical restenosis (10.3% vs 13.5%, OR 0.75, P = .004), MACE (16.5% vs 20.9%, OR 0.75, P < .001), 6-month target lesion restenosis (7.8% vs 10.2%, OR 0.75, P = .006), and 5-year target lesion restenosis (12.0% vs 14.0%, OR 0.83, P = .046).Conclusions beta-Adrenergic receptor blockers prescribed after PCI reduced the risk of clinical restenosis, target lesion restenosis, and MACE in this cohort of 4840 patients. The mechanism by which beta-blockers conferred a protective effect against restenosis remains to be determined.