Am J Cardiol：药物洗脱支架置入后伴钙化病变患者远期转归不佳
2013-05-30 高晓方 译 医学论坛网
日本一项研究表明，无论是否实施血液透析，西罗莫司洗脱支架置入后伴钙化病变的患者均出现死亡和靶病变血运重建远期风险升高。论文于5月23日在线发表于《美国心脏病学杂志》（Am J Cardiol）。 此项研究共纳入10595例仅接受西罗莫司洗脱支架治疗的患者（16803处病变）。对伴有≥1处中、重度钙化病变的患者（钙化组）和无钙化病变的患者（非钙化组）进行5年转归比较。依
日本一项研究表明，无论是否实施血液透析，西罗莫司洗脱支架置入后伴钙化病变的患者均出现死亡和靶病变血运重建远期风险升高。论文于5月23日在线发表于《美国心脏病学杂志》（Am J Cardiol）。
此项研究共纳入10595例仅接受西罗莫司洗脱支架治疗的患者（16803处病变）。对伴有≥1处中、重度钙化病变的患者（钙化组）和无钙化病变的患者（非钙化组）进行5年转归比较。依据血液透析状况进行分层分析（非血透层和血透层）。
结果显示，在非血透层（P=0.003）和血透层（P<0.0001）中，钙化组的死亡和靶病变血运重建校正风险均较显著。在血透层钙化组中确定性支架血栓形成的风险较高（危险比[HR] 5.05），但在非血透层中并非如此（HR 1.16）。在非血透层和血透层中，伴有严重钙化的患者应用冠脉旋磨术并未对靶病变血运重建的累积发病率造成显著影响。
与药物洗脱支架相关的拓展阅读：
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Comparison of Outcomes Using the Sirolimus-Eluting Stent in Calcified Versus Non-Calcified Native Coronary Lesions in Patients On- Versus Not On-Chronic Hemodialysis (from the j-Cypher Registry)
Abstract
The impact of lesion calcium on long-term outcomes after drug-eluting stent implantation has not been adequately addressed. In 10,595 patients (16,803 lesions) who were exclusively treated with sirolimus-eluting stents in the j-Cypher registry, 5-year outcomes were compared between patients with ≥1 lesion with moderate or severe calcification (the calcium group) and those with noncalcified lesions only (the noncalcium group). Analyses were stratified by hemodialysis (HD) status (non-HD stratum [calcium n = 3,191, noncalcium n = 6,824] and HD stratum [calcium n = 415, noncalcium n = 165]). Adjusted risk in the calcium group for death and target lesion revascularization was significant in the non-HD stratum (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.18 to 1.52, p <0.0001, and HR 1.2, 95% CI 1.07 to 1.36, p = 0.003) and the HD stratum (HR 1.4, 95% CI 1.06 to 1.86, p = 0.02, and HR 2.25, 95% CI 1.51 to 3.36, p <0.0001). Risk for definite stent thrombosis tended to be higher in the calcium group in the HD stratum (HR 5.05, 95% CI 0.66 to 38.9, p = 0.12) but not in then non-HD stratum (HR 1.16, 95% CI 0.81 to 1.67, p = 0.41). The use of rotational atherectomy in patients with severe calcification did not have a significant impact on the cumulative incidence of target lesion revascularization in the non-HD stratum (17.7% [n = 268] with vs 18.2% [n = 588] without rotational atherectomy, p = 0.68) and the HD stratum (54.7% [n = 115] with vs 51.9% [n = 118] without rotational atherectomy, p = 0.19). In conclusion, regardless of HD status, patients with calcified lesions have increased long-term risk for death and target lesion revascularization after sirolimus-eluting stent implantation.
Abstract
The impact of lesion calcium on long-term outcomes after drug-eluting stent implantation has not been adequately addressed. In 10,595 patients (16,803 lesions) who were exclusively treated with sirolimus-eluting stents in the j-Cypher registry, 5-year outcomes were compared between patients with ≥1 lesion with moderate or severe calcification (the calcium group) and those with noncalcified lesions only (the noncalcium group). Analyses were stratified by hemodialysis (HD) status (non-HD stratum [calcium n = 3,191, noncalcium n = 6,824] and HD stratum [calcium n = 415, noncalcium n = 165]). Adjusted risk in the calcium group for death and target lesion revascularization was significant in the non-HD stratum (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.18 to 1.52, p <0.0001, and HR 1.2, 95% CI 1.07 to 1.36, p = 0.003) and the HD stratum (HR 1.4, 95% CI 1.06 to 1.86, p = 0.02, and HR 2.25, 95% CI 1.51 to 3.36, p <0.0001). Risk for definite stent thrombosis tended to be higher in the calcium group in the HD stratum (HR 5.05, 95% CI 0.66 to 38.9, p = 0.12) but not in then non-HD stratum (HR 1.16, 95% CI 0.81 to 1.67, p = 0.41). The use of rotational atherectomy in patients with severe calcification did not have a significant impact on the cumulative incidence of target lesion revascularization in the non-HD stratum (17.7% [n = 268] with vs 18.2% [n = 588] without rotational atherectomy, p = 0.68) and the HD stratum (54.7% [n = 115] with vs 51.9% [n = 118] without rotational atherectomy, p = 0.19). In conclusion, regardless of HD status, patients with calcified lesions have increased long-term risk for death and target lesion revascularization after sirolimus-eluting stent implantation.
作者：高晓方 译
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