第一代或新一代SLF植入左冠状动脉主干10年后的临床结果

IF 5.9 2区医学 Q2 Medicine

Revista espanola de cardiologia Pub Date : 2025-03-21 DOI:10.1016/j.recesp.2025.02.003

Jens Wiebe , Constantin Kuna , Tareq Ibrahim , Sebastian Kufner , Isabella Hintz , Paul Justenhoven , Thorsten Kessler , Heribert Schunkert , Marco Valgimigli , Gert Richardt , Jola Bresha , Karl-Ludwig Laugwitz , Adnan Kastrati , Salvatore Cassese

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引用次数: 0

摘要

前言与目的：左冠状动脉主干（LMCA）支架置入术后的长期数据很少，特别是新一代药物洗脱支架（DES）。本分析旨在描述不同DES代LMCA疾病患者经皮冠状动脉介入治疗的10年临床结果。方法收集随机对照ISAR-LEFT MAIN和ISAR-LEFT MAIN 2试验的个体患者资料，进行10年临床随访。使用Kaplan-Meier方法计算事件率。该分析的主要终点是全因死亡率、心肌梗死、靶病变血运重建和明确的支架血栓形成。结果共纳入1257例患者，其中新一代DES治疗650例，早期DES治疗607例，10年时两组患者死亡率均大于40%。经统计校正后，新一代DES患者的10年死亡率明显低于早期DES患者（HRadj, 0.78; 95%CI, 0.62-0.97）。10年后，新一代DES与早期DES相比，心肌梗死（HRadj, 0.43; 95%CI, 0.23-0.80）、靶区血管重建（HRadj, 0.66; 95%CI, 0.49-0.89）、明确支架血栓形成（HRadj, 0.13, 95%CI, 0.04-0.49）的风险均显著降低。结论无论DES代如何，接受经皮冠状动脉介入治疗LMCA疾病的患者10年死亡率均较高。与早期DES相比，新一代DES在LMCA患者中的使用与改善的长期临床结果相关。

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Resultados clínicos a 10 años tras el implante de SLF de primera o nueva generación en el tronco coronario izquierdo

Introduction and objectives

Long-term data after stenting of the left main coronary artery (LMCA) are scarce, especially regarding new-generation drug-eluting stents (DES). This analysis aimed to describe the 10-year clinical outcomes of patients who underwent percutaneous coronary intervention with different DES generations for LMCA disease.

Methods

Individual patient data from the randomized controlled ISAR-LEFT MAIN and ISAR-LEFT MAIN 2 trials were pooled and 10-year clinical follow-up was obtained. The Kaplan-Meier method was used to calculate event rates. The main endpoints of interest for this analysis were all-cause mortality, myocardial infarction, target lesion revascularization and definite stent thrombosis.

Results

A total of 1257 patients were included in this analysis, of which 650 patients were treated with new-generation DES and 607 with early-generation DES. At 10 years, the mortality rate was more than 40% in both groups. After statistical adjustment, 10-year mortality was significantly reduced in patients treated with new-generation DES compared with those treated with early-generation DES (HR_adj, 0.78; 95%CI, 0.62-0.97). After 10 years, the risk of myocardial infarction (HR_adj, 0.43; 95%CI, 0.23-0.80), target lesion revascularization (HR_adj, 0.66; 95%CI, 0.49-0.89), and definite stent thrombosis (HR_adj, 0.13, 95%CI, 0.04-0.49) was significantly reduced by new-generation DES compared with early-generation DES.

Conclusions

Patients undergoing percutaneous coronary intervention for LMCA disease have high 10-year mortality regardless of DES generation. The use of new-generation DES in patients with LMCA disease is associated with improved long-term clinical outcomes compared with early-generation DES.

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来源期刊

Revista espanola de cardiologia 医学-心血管系统

CiteScore

4.20

自引率

13.60%

发文量

257

审稿时长

28 days

期刊介绍： Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.