TCT2008回顾：应用DES治疗无保护左主干4年结果安全
来源：医心网 发布时间：2008-11-04 14:16
TCT2008回顾：应用DES治疗无保护左主干4年结果安全
From TCT 2008: DES in Unprotected Left Main Disease Safe at 4 Years
要点：
·4年时DES支架血栓发生率低
·再狭窄率20.5%
根据华盛顿召开的TCT2008会议公布的2项注册研究，长期随访数据显示，应用药物洗脱支架（DES）对于无保护左主干冠脉疾病（LMCA）的治疗是安全有效的。
意大利米兰市·圣拉菲尔医院的Valeria Magni博士，报告了107例无保护LMCA 患者置入Taxus（波科）紫杉醇洗脱支架或者Cypher（强生）西罗莫司洗脱支架的4年结果。结果显示可接受的低临床事件率：13例（12%）死亡——均在第一年发生（见表格）。
报告发生10例非Q波心梗。造影随访96例患者发现22例再狭窄（20.5%），其中21例患者进行远端左主干疾病的治疗。平均晚期丢失为0.58mm2.
“无保护LMCA狭窄应用DES，明确的和很有可能的血栓发生率较低。”Magni博士说。
2年随访
来自圣拉菲尔医院和纽约哥伦比亚大学医学中心LMCA患者DES治疗的2年随访报告中，圣拉菲尔医院的Alaide Chieffo博士说综合数据支持应用DES。
Chieffo 说，“对于DES无保护LMCA狭窄，DES似乎是安全的，2年随访仍保持良好的临床结果。”汇总分析的267例患者中，32例发生院内非Q波心梗（没有导致死亡）。2年随访时，21例死亡（7.8%），其中13例是心性死亡（4.8%）。
Chieffo 说，40例患者（14.9%）发生靶病变血运重建，54例（20.2%）发生靶血管血运重建，6例（2.2%）发生心梗。49例患者行再次PCI术，5例行CABG术。
3例患者（1.1%）发生了明确的支架血栓，2例患者发生很有可能的支架血栓（0.7%），6例患者发生可能的支架血栓（2.2%）。
（source：www.tctmd.com）
（《医心评论》 刘瑞琦 翻译 陆卫 校对）
From TCT 2008: DES in Unprotected Left Main Disease Safe at 4 Years
Key Points:
* Low stent thrombosis with DES at 4 years
* Restenosis rate at 20.5%
By TCT Daily Staff
Long-term follow-up data show that the use of drug-eluting stents (DES) can be safe and effective in unprotected left main coronary artery disease (LMCA), according to findings from 2 registries presented at TCT 2008 in Washington, DC.
Valeria Magni, MD, of San Raffaele Hospital (Milan, Italy). reported the 4-year outcomes of 107 patients with unprotected left main coronary artery disease implanted with either Taxus (Boston Scientific, Natick, MA) paclitaxel-eluting stents or Cypher (Cordis/Johnson & Johnson, Miami Lakes, FL) sirolimus-eluting stents. Results showed low, acceptable rates of clinical events, including 13 deaths (12%), all of which occurred within the first year (see Figure).
Ten non-Q-wave MIs were reported. Angiographic follow-up in 96 patients identified 22 cases (20.5%) of restenosis, 21 of those in patients treated for distal left main disease. Mean late loss was 0.58 mm2.
“Use of DES in unprotected LMCA stenosis appears also to have a low incidence of definite and probable [stent thrombosis],” Dr. Magni said.
Two-Year Follow-up
In a separate presentation of 2-year follow-up in LMCA patients treated with DES at San Raffaele Hospital and Columbia University Medical Center (New York, NY), Alaide Chieffo, MD, of San Raffaele Hospital (Milan, Italy), said that the combined data support the use of DES.
“The elective treatment of unprotected LMCA stenosis with DES appears safe with favorable clinical results maintained at 2-year clinical follow-up,” Dr. Chieffo said. In the 267 patients in the combined analysis, there were 32 incidents of in-hospital non-Q-wave myocardial infarction (MI) with no resulting mortality. At 2-year follow-up, there were 21 deaths (7.8%), 13 of which were cardiac deaths (4.8%).
Forty patients (14.9%) had target lesion revascularizations, 54 (20.2%) had target vessel revascularizations, and 6 (2.2%) had MIs. There were also 49 cases of re-PCI and 5 CABG procedures, Dr. Chieffo said.
Definite stent thrombosis occurred in 3 patients (1.1%), probable stent thrombosis in 2 (0.7%), and possible stent thrombosis in 6 (2.2%).
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