Is a bare-metal stent still useful for improving the outcome of percutaneous coronary intervention? From the FU-Registry
Is a bare-metal stent still useful for improving the outcome of percutaneous coronary intervention? From the FU-Registry
复制标题
裸金属支架对于改善经皮冠状动脉介入治疗的结果仍然有用吗？
作者：
GONDO;K.;IKE;A.;OGAWA;M.;SHIRAI;K.;SUGIHARA;M.;NISHIKAWA;H.;IWATA;A.;KAWAMURA;A.;MORI;K.;ZHANG;B.;MIURA;S.;YASUNAGA;S. & SAKU;K.
背景冠状动脉药物洗脱支架（DES）介入治疗（PCI）已越来越多地应用于冠心病的治疗。然而，裸金属支架（BMS）PCI的作用和有效性尚未确定。2003年至2012年在福冈的三家机构接受PCI治疗的2653处病变，859名患者（1032处病变）没有急性冠状动脉综合征，并且我们能够对其进行随访-选择支架置入后行冠状动脉造影并收集详细资料进行本研究。在接受BMS治疗的患者中，通过比较有和无支架内再狭窄（ISR）的患者，计算支架内再狭窄（ISR）发生的截止病变参考值。在所有病变参考高于/低于BMS-ISR截止点的患者中，BMS和DES组之间的中期临床和血管造影结果进行了比较。结果在接受BMS治疗的患者中，病变参考[比值比0.68，95%置信区间（CI）0.43 - 0.97，p = 0.03]与ISR密切相关，受试者工作特征曲线下面积为0.704，准确性中等。使用相对累积频率分布和灵敏度/特异性曲线计算BMS-ISR的截止病变参考值，显示BMS-ISR的截止病变参考值为3.08 mm，灵敏度/特异性为60.4%。对于病变参考超过3.08 mm的DES和BMS组，BMS放置与ISR不相关（比值比0.98，95%CI 0.85 - 1.12），BMS与主要不良心脏事件之间也无相关性。使用DES和BMS的中期临床和血管造影结局等同。因此，BMS放置是值得考虑的，特别是在病变参考直径≥ 3.08 mm的患者中，需要在早期停止双重抗血小板治疗。
BackgroundPercutaneous coronary intervention (PCI) with a drug-eluting stent (DES) is increasingly being used for the treatment of coronary artery diseases. However, the role and effectiveness of PCI with a bare metal stent (BMS) have not yet been established.MethodsAmong the 2197 patients (2653 lesions) treated with PCI from 2003 to 2012 at three institutions in Fukuoka, 859 patients (1032 lesions) without acute coronary syndrome and in whom we were able to perform follow-up coronary angiography after stent placement and collect detailed data were selected for this study. Among the patients treated by BMS, the cut-off lesion reference for the development of in-stent restenosis (ISR) was calculated by comparing patients with and without ISR. In all patients with a lesion reference above/below the cut-off point of BMS-ISR, medium-term clinical and angiographic outcomes were compared between the BMS and DES groups.ResultsIn patients treated with a BMS, the lesion reference [odds ratio 0.68, 95% confidence interval (CI) 0.43–0.97,p= 0.03] was strongly correlated with ISR, and the area under the receiver operating characteristic curve was 0.704, with moderate accuracy. Calculation of the cut-off lesion reference for BMS-ISR, using a relative cumulative frequency distribution and a sensitivity/specificity curve, showed that the cut-off lesion reference for BMS-ISR was 3.08 mm, and the sensitivity/specificity was 60.4%. For the DES and BMS groups in cases with a lesion reference over 3.08 mm, BMS placement did not correlate with ISR (odds ratio 0.98, 95% CI 0.85–1.12), and there was also no correlation between BMS and major adverse cardiac events.ConclusionIn patients with a lesion reference ≧ 3.08 mm, medium-term clinical and angiographic outcomes were equivalent between the use of a DES and BMS. Thus, BMS placement is well worth considering, especially in patients with a lesion reference ≧ 3.08 mm, in whom double-antiplatelet therapy needs to be stopped at an early stage.