Ten-year clinical outcomes after drug-eluting stents implantation according to clinical presentation—Insights from the DECADE cooperation

IF 4.4 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Fabian Starnecker, J. J. Coughlan, Lisette Okkels Jensen, Sarah Bär, Sebastian Kufner, Salvatore Brugaletta, Lorenz Räber, Michael Maeng, Luis Ortega-Paz, Dik Heg, Karl-Ludwig Laugwitz, Manel Sabaté, Stephan Windecker, Adnan Kastrati, Kevin Kris Warnakula Olesen, Salvatore Cassese
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Abstract

Background

Investigations of very long-term outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) according to clinical presentation are scarce. Here, we investigated the 10-year clinical outcomes of patients undergoing DES-PCI according to clinical presentation.

Methods

Patient-level data from five randomized trials with 10-year follow-up after DES-PCI were pooled. Patients were dichotomized into acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) groups as per clinical presentation. The primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST) and repeat revascularization involving the target lesion (TLR), target vessel (TVR) or non-target vessel (nTVR).

Results

Of the 9700 patients included in this analysis, 4557 presented with ACS and 5143 with CCS. Compared with CCS patients, ACS patients had a higher risk of all-cause death and nTVR in the first year, but comparable risk thereafter. In addition, ACS patients had a higher risk of MI [adjusted hazard ratio 1.21, 95% confidence interval (1.04–1.41)] and definite ST [adjusted hazard ratio 1.48, 95% confidence interval (1.14–1.92)], while the risk of TLR and TVR was not significantly different up to 10-year follow-up.

Conclusions

Compared to CCS patients, ACS patients treated with PCI and DES implantation have an increased risk of all-cause death and repeat revascularization of remote vessels up to 1 year, with no significant differences thereafter and up to 10-year follow-up. ACS patients have a consistently higher risk of MI and definite ST. Whether these differences persist with current antithrombotic and secondary prevention therapies requires further investigation.

Abstract Image

根据临床表现确定药物洗脱支架植入术后十年临床疗效--DECADE 合作项目的启示。
背景:根据临床表现对使用药物洗脱支架(DES)进行经皮冠状动脉介入治疗(PCI)后的长期疗效进行调查的研究很少。在此,我们根据临床表现调查了接受 DES-PCI 患者的 10 年临床预后:方法:汇总了五项随机试验中接受 DES-PCI 术后 10 年随访的患者数据。根据临床表现将患者分为急性冠状动脉综合征(ACS)组和慢性冠状动脉综合征(CCS)组。主要结果是全因死亡。次要结果是心血管死亡、心肌梗死(MI)、明确的支架血栓形成(ST)和涉及靶病变(TLR)、靶血管(TVR)或非靶血管(nTVR)的重复血管再通:在纳入本次分析的 9700 名患者中,4557 人患有 ACS,5143 人患有 CCS。与 CCS 患者相比,ACS 患者第一年的全因死亡和 nTVR 风险较高,但之后的风险相当。此外,ACS患者发生心肌梗死[调整后危险比为1.21,95%置信区间为(1.04-1.41)]和明确ST[调整后危险比为1.48,95%置信区间为(1.14-1.92)]的风险较高,而TLR和TVR的风险在10年随访期间没有显著差异:结论:与CCS患者相比,接受PCI和DES植入治疗的ACS患者全因死亡和远端血管重复血运重建的风险在1年内会增加,但在1年后和10年随访期间无明显差异。ACS 患者发生 MI 和明确 ST 的风险一直较高。这些差异在目前的抗血栓和二级预防疗法中是否仍然存在,还需要进一步研究。
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来源期刊
CiteScore
9.50
自引率
3.60%
发文量
192
审稿时长
1 months
期刊介绍: EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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