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Comparison of the Efficacy of Drug-eluting Stents Versus Bare-metal Stents for the Treatment of Left Main Coronary Artery Disease

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文摘 Background: Recent studies reported that percutaneous coronary intervention with stent implantation was safe and feasible for the treatment of left main coronary artery (LMCA) disease in select patients. However, it is unclear whether drug-eluting stents (DESs) have better outcomes in patients with LMCA disease compared with bare-metal stent (BMS) during long-term follow-up in Chinese populations. Methods: From a perspective multicenter registry, 1136 consecutive patients, who underwent BMS or DES implantation for unprotected LMCA stenosis, were divided into two groups: 1007 underwent DES implantation, and 129 underwent BMS implantation. The primary outcome was the rate of major adverse cardiac events (MACEs), including cardiovascular (CV) death, myocardial infarction (MI), and target lesion revascularization (TLR) at 5 years postimplantation. Results: Patients in the DES group were older and more likely to have hyperlipidemia and bifurcation lesions. They had smaller vessels and longer lesions than patients in the BMS group. In the adjusted cohort of patients, the DES group had significantly lower 5 years rates of MACE (19.4% vs. 31.8%, P = 0.022), CV death (7.0% vs. 14.7%, P= 0.045), and MI (5.4% vs. 12.4%, P= 0.049) than the BMS group. There were no significant differences in the rate of TLR (10.9% vs. 17.8%, P= 0.110) and stent thrombosis (4.7% vs. 3.9%, P = 0.758). The rates of MACE (80.6% vs. 68.2%, P = 0.023), CV death (93.0% vs. 85.3%, P = 0.045), TLR (84.5% vs. 72.1%, P = 0.014), and MI (89.9% vs. 80.6%, P = 0.029) free survival were significantly higher in the DES group than in the BMS group. When the propensity score was included as a covariate in the Cox model, the adjusted hazard ratios for the risk of CV death and MI were 0.41 (95% confidence interval [CI]: 0.21-0.63, P = 0.029) and 0.29 (95% CI: 0.08-0.92, P= 0.037), respectively. Conclusions: DES implantation was associated with more favorable clinical outcomes than BMS implantation for the treatment of LMCA disease even though there was no significant difference in the rate of TLR between the two groups.
来源 Chinese Medical Journal ,2015,128(6):721-726 【核心库】
DOI 10.4103/0366-6999.152460
关键词 Bare-metal Stent ; Drug-eluting Stent ; Left Main Coronary Artery Disease ; Percutaneous Coronary Intervention
地址

1. Department of Cardiology, General Hospital of Shenyang Military Region, Liaoning, Shenyang, 110840  

2. Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University, Jiangsu, Nanjing, 210006

语种 英文
文献类型 研究性论文
ISSN 0366-6999
学科 内科学
文献收藏号 CSCD:5363378

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引证文献 3 篇

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