“真实世界”药物涂层支架(DES)植入后5年随访研究
Five-year following-up after implantation of drug-eluting stent
-
摘要: 目的 研究第一代药物洗脱支架治疗冠心病远期(5年)临床疗效。明确晚期主要心血管事件的发生率。方法 对2004年1月-12月就诊于我中心并成功植入DES的156例冠心病患者进行随访调查,为单中心非对照的登记研究,随访5年的主要心血管事件发生率。主要终点:观察主要不良心血管事件(Major Adverse Cardiac Events,MACE)发生情况;次要终点:心绞痛复发和非靶血管的血运重建。结果 156例冠心病DES植入者成功随访,随访时间(5.21±0.32)年。主要MACE发生32例(21%),其中心原性死亡5例(3.2%,心原性猝死3例,心衰和急性心肌梗死各1例),靶病变/靶血管的再次血运重建19例(12.2%),再次非致命性心梗8例(5.1%),心绞痛复发43例(27.6%),其他血管血运重建及CABG治疗6例。脑出血、感染、肿瘤死亡各1例。Logistic回归分析显示氯吡格雷服用时间(P=0.016,OR=1.1,95%CI:1.018-1.188)和多支血管病变(P=0.039,OR=3.35,95%CI:1.06-10.55)是MACE发生的独立危险因素。结论 多支血管病变者MACE发生率增加;服用氯吡格雷时间长者并未在MACE发生方面绝对获益。Abstract: Objective To study the incidence of major cardiovascular events by observing the clinical outcome of the first-generation drug-eluting stents(DES) 5 years after implantation. Methods The incidence of major cardiovascular events,including recurrent angina pectoris and revascularization of non-target vessels,was investigated in 156 patients who underwent DES implantation in our centre from January to December 2004. Results The follow-up time of the 156 patients who underwent DES implantation was 5.21±0.32 years.Of the 32 patients(21%) who developed major cardiovascular events,5 died of cardiac diseases(3.2%).Lesion and revascularization of target blood vessels were observed in 19 patients(12.2%).Recurrent non-fatal cardiac infarction and angina pectoris occurred in 8 patients(5.1%) and 43 patients(27.6%),respectively.Revascularization in other blood vessels was observed in 6 patients who received CABG treatment.Cerebral hemorrhage and infection were found,respectively,in 1 patient.One patient died of tumor.Logistic regression analysis showed that the clopidogrel treatment time(P=0.016,OR=1.1,95%CI=1.018-1.188) was an independent risk factor for major cardiovascular events(P=0.039,OR=3.35,95%CI:1.06-10.55). Conclusion The incidence of major cardiovascular events increased in patients with lesions of multiple blood vessels,which is not reduced after long-term clopidogrel therapy.
下载: