Risk of mortality and stroke after atrial fibrillation
Risk of mortality and stroke after atrial fibrillation
复制标题
DOI：
10.1016/s0140-6736(17)30589-5
复制
发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
C. Mihas;A. Mariolis;K. Letsas;M. Kantzanou
中科院分区：
文献类型：
--
作者：
C. Mihas;A. Mariolis;K. Letsas;M. Kantzanou
Patrick Serruys及其同事1在《柳叶刀》(11月19日，第2479页)上发表的多中心随机吸收II研究的结果并未表明，与药物洗脱支架相比，生物可吸收血管支架在晚期管腔丢失(再狭窄)或血管舒缩反应方面的优势。今年早些时候，NORSTENT多中心随机选择的经皮冠状动脉介入治疗试验2显示，接受药物洗脱支架和裸金属支架的参与者在死于任何原因和非致命性心肌梗死的综合结果方面没有显著差异。这两项研究的结果1、2清楚地表明，始于1987年的支架革命3已经回到了原点(附录)。30年来，几种技术或药物来来去去。裸金属支架技术已经演变成药物洗脱支架技术，显著减少了再狭窄，但代价是长期的双重抗血小板治疗。临床医生正试图用更昂贵的技术实现乌托邦式的0%再狭窄，这些技术带来了新的问题，如血栓形成、新的动脉粥样硬化、支架回缩，以及更强的更长时间的药物治疗。吸收II和NORSTENT研究1，2挑战了通常的趋势，即展示新事物比实际情况更闪亮，而旧事物更灰暗。5临床医生在大规模采用新技术之前，应反思和使用经得起时间考验的具有成本效益的技术。研究人员应该考虑这类技术是否已经达到顶峰，以及是否仍然值得追求乌托邦式的目标，即通过消失的支架实现0%的再狭窄，事实证明，这种支架的安全性低于其他可用的技术。
The results of the multicenter randomised ABSORB II study by Patrick Serruys and colleagues1 published in The Lancet (Nov 19, p 2479) did not show non-inferiority in terms of late luminal loss (restenosis) or superiority in vasomotor reactivity of the bioresorbable vascular scaffolds compared with the drug-eluting stents. Earlier this year, the multicenter randomised NORSTENT elective percutaneous coronary intervention trial2 showed no significant differences between participants receiving drug-eluting stents and those receiving bare-metal stents in the composite outcome of death from any cause and non-fatal myocardial infarctions. The results of these two studies1, 2 clearly show that the stent revolution, which started in 1987, 3 has come full circle (appendix). Over 30 years, several technologies or drugs have come and gone. The bare-metal stent technology has evolved into the drug-eluting stent technology that has produced a marked reduction in restenosis, at a cost of longer term dual antiplatelet therapy. 4 Clinicians are trying to achieve the utopian 0% restenosis with more expensive technologies that present new problems such as thrombosis, neoatherosclerosis, stent recoil, and much stronger medications for longer durations. The ABSORB II and NORSTENT studies1, 2 challenge the typical trend of showing the new thing to be shinier and the old thing dustier than they really are. 5 Clinicians should reflect and use costeffective technologies that have stood the test of time before adopting newer technologies on a large scale. Researchers should consider whether the peak for this type of technology has already been reached, and whether the utopian goal of 0% restenosis with a disappearing stent that proves less safe than other available technology is still worth pursuing.