Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.
Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.
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DOI：
10.1002/ccd.21930
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发表时间：
2009-05-01
影响因子：
2.3
通讯作者：
Hochman, Judith S.
中科院分区：
文献类型：
--
作者：
Dzavik, Vladimir;Buller, Christopher E.;Devlin, Gerard;Carere, Ronald G.;Mancini, G. B. John;Cantor, Warren J.;Buszman, Pawel E.;Rankin, James M.;Vozzi, Carlos;Ross, John R.;Forman, Sandra;Barton, Bruce A.;Lamas, A. Gervasio A.;Hochman, Judith S.
关键词：
闭塞动脉试验（OAT）及其血管造影子研究加拿大完全闭塞研究2（TOSCA-2）中随机接受经皮冠状动脉介入治疗（PCI）的大多数患者均接受裸金属支架（BMS）治疗。我们的目的是确定与BMS治疗相比，使用药物洗脱支架（DES）对OAT目标闭塞进行支架植入是否与更有利的血管造影结果和临床结局相关。TOSCA-2 DES是一项前瞻性非随机子研究，提供了25例接受DES治疗的患者和128例接受BMS治疗的患者的1年晚期丢失和再闭塞的血管造影比较。此外，对首次使用DES时入组的所有PCI分配患者进行相似分类（DES n = 77，BMS n = 386），并使用3年累积OAT主要联合终点（死亡、心肌梗死或IV级心力衰竭以及心绞痛）进行比较。DES和BMS的节段内晚期丢失分别为0.14 ± 0.45 mm和0.75 ± 0.86 mm（P < 0.001）。相应的二元再狭窄率分别为13.0%和44.3%（P = 0.005）。1年时的闭塞率分别为4.0%和12.1%（P = 0.23）。DES组的3年累积主要事件发生率为13.8%，BMS组为12.5%（风险比1.08，99%置信区间0.44，2.64; P = 0.83）。DES组随着时间推移发生心绞痛的频率较低（P = 0.01）。尽管使用DES对心肌梗死后3-28天持续闭塞的伊拉进行PCI的晚期丢失减少和再闭塞减少的趋势并没有转化为死亡、再梗死或IV级心力衰竭减少的信号，但随着时间的推移，DES的使用与心绞痛减少相关。需要采取进一步的后续行动。
The majority of patients randomized to percutaneous coronary intervention (PCI) in the Occluded Artery Trial (OAT) and its angiographic substudy, the Total Occlusion Study of Canada 2 (TOSCA-2) were treated with bare metal stents (BMS). We aimed to determine if stenting of the target occlusion in OAT with drug-eluting stents (DES) was associated with more favorable angiographic results and clinical outcome when compared with treatment with BMS. TOSCA-2 DES was a prospective nonrandomized substudy that provided 1-year angiographic comparison of late loss and reocclusion in 25 patients treated with DES and in 128 treated with BMS. In addition, all PCI-assigned patients enrolled from the time when DES were first utilized were similarly categorized (DES n = 77, and BMS n = 386) and compared using the 3-year cumulative OAT primary combined endpoint of death, myocardial infarction, or Class-IV heart failure, as well as angina. In-segment late loss was 0.14 ± 0.45 mm for DES and 0.75 ± 0.86 mm for BMS (P < 0.001). Corresponding binary restenosis rates were 13.0% and 44.3% (P = 0.005). Occlusion at 1 year was observed in 4.0 and 12.1%, respectively (P = 0.23). The 3-year cumulative primary event rate was 13.8% with DES and 12.5% with BMS (hazard ratio 1.08, 99% confidence intervals 0.44, 2.64; P = 0.83). Angina over time occurred less frequently in the DES group (P = 0.01). Although the reduction of late loss and trend to reduction in reocclusion with the use of DES for PCI of persistently occluded IRA 3–28 days post myocardial infarction did not translate into a signal for reduction in death, reinfarction, or Class IV heart failure, DES use was associated with less angina over time. Further follow-up is warranted.
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DOI：
10.1016/s0735-1097(98)00193-4
发表时间：
1998-07-01
影响因子：
24
作者：
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影响因子：
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