Drug-eluting Stents Associated With Positive Outcomes Over Time

　　尽管时间不断推移，但药物释放支架的不良事件率却保持了稳定，无论心梗，靶病变血运重建率，出血，院内支架血栓还是晚期支架血栓发生率在2004－2006年间都没有显著差异。

　　另外，EVENT注册研究的数据还显示氯吡格雷在过去三年中被广泛的使用。术前进行充分治疗的几率（定义为术前一周氯吡格雷300mg，或PCI术两小时前600mg符合剂量）从第一期的35%提高到了第二期的43%及第三期的46%。

　　院内缺血事件并发症率也随着时间推移不断下降。急诊血运重建的比例在一期为0.9%，降低到了二期的0.7%和三期的0.4%。靶病变血运重建率从一期的5.1%降低到了三期的3.8%。死亡和心梗发生率从一期到三期基本保持了稳定，死亡率波动在2%－4%，心梗率波动在5%－8%之间。

　　出血并发症也随着时间推移而下降 (图1).

　　无论院内，6个月还是12个月，支架血栓率在三个时期内都不断下降(图2).

　　EVENT注册研究旨在评价2004－2006年三年间支架术并发症的变化情况。每一期大概观察2500名患者，所有患者均接受FDA批准的冠脉支架治疗。

　　在第三期内，88.2%的患者采用了药物释放支架，而2.7%同时采用了药物释放支架和裸支架。研究由Neil Kleiman教授进行，他是Methodist DeBakey心脏病中心介入室的主任。

　　（北京协和医院　鲁勖　编译）

Drug-eluting Stents Associated With Positive Outcomes Over Time

EVENT registry researchers examined drug eluting stent use over three time periods.

Over three time periods between 2004 and 2006, treatment with DES was associated with little change in mortality or MI and decreased rates of TLR, hemorrhage, in-hospital stent thrombosis, and late-stent thrombosis.

In addition, data from the EVENT registry indicated that clopidogrel use improved over the three time periods. Adequate treatment — defined as either clopidogrel treatment 1 week prior, 300 mg at least 6 hours prior, or 600 mg at least 2 hours prior to PCI — increased from 35% in wave 1 (July 2004 to March 2005) to 43% in wave 2 (June 2005 to September 2005) and to 46% in wave 3 (February 2006 to June 2006).

In-hospital ischemic complications, meanwhile, decreased over time. Need for urgent revascularization was observed in 0.9% of patients in wave 1, 0.7% of patients in wave 2, and 0.4% for wave 3. TLR also decreased, from 5.1% in wave 1 to 3.8% in wave 3 (P = .019). Death and MI remained generally stable from wave 1 to wave 3 (between 2% and 4% for death and between 8% and 9.5% for MI).

Bleeding complications also decreased over time (Figure 1).

 
Adjudicated stent thrombosis decreased over the three time waves, whether measurements were in-hospital, at 6 months, or 12 months (Figure 2).

 
The EVENT registry was designed to measure the implications of changing stent practice from 2004 to 2006.

Patients were enrolled in waves of approximately 2,500 patients per wave in which all patients receiving
any FDA-approved intracoronary stent were eligible.

During wave 3, 88.2% of patients were treated with a DES alone, whereas 2.7% were treated with both
a DES and a bare-metal stent.

The registry was presented by Neil Kleiman, MD, director of the cardiac catheterization laboratory at
Methodist DeBakey Heart Center in Houston.