Predictive factors of restenosis after coronary implantation of sirolimus- or paclitaxel-eluting stents
Predictive factors of restenosis after coronary implantation of sirolimus- or paclitaxel-eluting stents
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DOI：
10.1161/circulationaha.105.601823
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发表时间：
2006-05-16
期刊：
影响因子：
37.8
通讯作者：
Schöming, A
中科院分区：
文献类型：
--
作者：
Kastrati, A;Dibra, A;Schöming, A
背景-药物洗脱支架在降低再狭窄风险方面的疗效在不同患者亚群中并不一致。确定再狭窄的预测因素可能有助于改善经皮冠状动脉介入治疗后的结果。方法和结果-2002年8月至2004年12月期间在自体血管中成功植入西罗莫司或紫杉醇洗脱支架治疗原发病变的所有患者都有资格参加本研究。所有数据都是前瞻性收集的。血管造影再狭窄定义为随访时节段内区域直径狭窄≥ 50%。靶病变血运重建定义为涉及靶病变的任何血运重建手术。本研究纳入了1845例患者的2093处靶病变。多变量分析显示，血管尺寸、最终狭窄直径和药物洗脱支架类型是再狭窄的最强预测因子。血管尺寸减小0.5 mm与血管造影再狭窄的校正比值比（OR）为1.74（95% CI，1.31 - 2.32）和靶病变血运重建的校正比值比（OR）为1.65（95% CI，1.22 - 2.23）相关。最终直径狭窄增加5%与血管造影再狭窄的校正OR 1.30（95% CI，1.15 - 1.47）和靶病变血运重建的校正OR 1.18（95% CI，1.03 - 1.35）相关。与紫杉醇洗脱支架相比，西罗莫司洗脱支架的校正OR为0.60（95% CI，0.44 - 0.81）血管造影再狭窄和0.67（95%CI，0.49至0.91）为靶病变血运重建。结论-血管尺寸和药物洗脱支架类型是血管造影和临床再狭窄的最重要预测因子，药物洗脱支架类型对小冠状血管的再狭窄具有特别的影响。
Background-The efficacy of drug-eluting stents in reducing restenosis risk has not been uniform across patient subsets. Identifying predictive factors of restenosis may help improve outcomes after percutaneous coronary interventions.Methods and Results-All patients who underwent successful implantation of sirolimus- or paclitaxel-eluting stents in native vessels for de novo lesions between August 2002 and December 2004 were eligible for this study. All data were prospectively collected. Angiographic restenosis was defined as diameter stenosis >= 50% at follow-up in the in-segment area. Target lesion revascularization was defined as any revascularization procedure involving the target lesion. Included in this study were 1845 patients with 2093 target lesions. Multivariable analysis showed that vessel size, final diameter stenosis, and drug-eluting stent type were the strongest predictors of restenosis. A 0.5-mm decrease in vessel size was associated with adjusted odds ratios (ORs) of 1.74 (95% CI, 1.31 to 2.32) for angiographic restenosis and 1.65 (95% CI, 1.22 to 2.23) for target lesion revascularization. A 5% increase in final diameter stenosis was associated with adjusted ORs of 1.30 (95% CI, 1.15 to 1.47) for angiographic restenosis and 1.18 (95% CI, 1.03 to 1.35) for target lesion revascularization. Compared with paclitaxel-eluting stent, sirolimus- eluting stent was associated with adjusted ORs of 0.60 (95% CI, 0.44 to 0.81) for angiographic restenosis and 0.67 (95% CI, 0.49 to 0.91) for target lesion revascularization.Conclusions-Vessel size and drug-eluting stent type are the most important predictors of angiographic and clinical restenosis, with drug-eluting stent type having a particular impact on restenosis of small coronary vessels.