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医汇心血管学术 > 麻萨诸塞州药物洗脱支架与裸金属支架长期临床结果

麻萨诸塞州药物洗脱支架与裸金属支架长期临床结果

发表于 2014-10-09 14:37:48
背景 药物洗脱支架(DES)减少了对再次血运重建的需要,但是相对于裸金属支架其远期安全性尚不明确。我们比较了DES及BMS置入后的两组病人的临床结果。 方法与结果 在2003.4.1到2004.9.30麻萨诸塞州非美国公立医院所有接受经皮冠状动脉介入及支架置入的成人患者被识别并入选进入数据库。根据应用的支架类型建立入院索引将患者分类。前瞻性的收集患者临床及操作危险因素。根据不重复抽样倾向性积分估算校正风险后的死亡率、心梗率及再次血运重建率差别(DES-BMS)。共11 556例患者置入DES,6237例患者置入BMS,未经调整的2年死亡率分别为 7.0%和 12.6%(P<0.0001),心梗率和靶血管血运重建率分别为8.3% vs . 10.3% (P=0.0005)及11.0% vs 16.8% (P<0.0001). 结论—同BMS相比,配对研究中类似患者DES治疗的死亡率、心梗率及靶血管血运重建率更低。有必要对包括这组病例在内的人群进行综合性随访以评价2年后能否继续维持其安全性和疗效。来源:丁香网Long-Term Clinical Outcomes After Drug-Eluting and Bare-Metal Stenting in MassachusettsBackground— Drug-eluting stents (DES) reduce the need for repeat revascularization, but their long-term safety relative to that of bare-metal stents (BMS) in general use remains uncertain. We sought to compare the clinical outcome of patients treated with DES with that of BMS.Methods and Results— All adults undergoing percutaneous coronary intervention with stenting between April 1, 2003, and September 30, 2004, at non–US government hospitals in Massachusetts were identified from a mandatory state database. Patients were classified from the index admission according to stent types used. Clinical and procedural risk factors were collected prospectively. Risk-adjusted mortality, myocardial infarction, and revascularization rate differences (DES–BMS) were estimated through propensity score matching without replacement. A total of 11 556 patients were treated with DES, and 6237 were treated with BMS, with unadjusted 2-year mortality rates of 7.0% and 12.6%, respectively (P<0.0001). In 5549 DES patients matched to 5549 BMS patients, 2-year risk-adjusted mortality rates were 9.8% and 12.0%, respectively (P=0.0002), whereas the respective rates for myocardial infarction and target-vessel revascularization were 8.3% versus 10.3% (P=0.0005) and 11.0% versus 16.8% (P<0.0001). Conclusions— DES treatment was associated with lower rates of mortality, myocardial infarction, and target-vessel revascularization than BMS treatment in similar patients in a matched population-based study. Comprehensive follow-up in this inclusive population is warranted to identify whether similar safety and efficacy remain beyond 2 years.source:circulation.com
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