JACC:美国超500万患者研究显示,近10%的PCI用于治疗支架内再狭窄

2020-09-24 心关注 心关注

经皮冠状动脉介入治疗(PCI)是目前冠心病治疗的主要手段之一,极大改善了冠心病患者的预后,但介入治疗后再狭窄一直是其无法摆脱的梦魇。

经皮冠状动脉介入治疗(PCI)是目前冠心病治疗的主要手段之一,极大改善了冠心病患者的预后,但介入治疗后再狭窄一直是其无法摆脱的梦魇。近日,发表在JACC上的一项研究发现,在美国,对支架内再狭窄病变进行PCI治疗时,通常会另外置入支架,研究还发现,与没有支架内再狭窄的患者相比,因支架内再狭窄而接受PCI的患者发生非ST段抬高型心肌梗死(non-STEMI)或ST段抬高型心肌梗死(STEMI)的可能性较小,但两组患者的住院并发症发生率和住院时间相似。

研究结果为临床医生提供了实际指导,帮助他们设定冠状动脉支架植入术患者的期望值,即在初始支架置入术后需要重复干预的潜在频率,强调遵循危险因素修正治疗和抗血小板治疗以减少支架置入后急性缺血性事件的重要性,并告知患者潜在的支架内再狭窄风险。当患者发生支架内再狭窄时,在美国最有可能接受的治疗是置入另一枚支架。

来自CathPCI注册研究的数据

在这项回顾性分析中,研究人员分析了2009年至2017年接受PCI治疗的美国国家血管数据注册登记(NCDR)CathPCI注册研究中5,100,394名患者(平均年龄65岁;68%为男性)的数据。有心源性休克或心脏骤停的患者,或接受抢救性PCI的患者不在本分析之列。主要的暴露变量是存在支架内再狭窄病变的患者,尽管在手术过程中有其他病变。第一次PCI被认为是接受多次PCI治疗患者的索引手术(index procedure)。

研究结果显示,有10.6%的患者因支架内再狭窄而接受PCI治疗。

研究作者表示,虽然有人可能会把支架内再狭窄的重复PCI的稳定率解释为缺乏进展,但必须记住,在这项研究期间,更多复杂病变的患者接受了冠状动脉支架治疗。因此,随着器械和植入技术的进步,需要重复干预的稳定率可能表明随着时间的推移支架的疗效会提高。当然,这只是一个假设,而不是本研究的观察结果。

对于支架内再狭窄接受PCI治疗的患者,裸金属支架内再狭窄的发生率从2009年第三季度到2017年第二季度有所下降(2.6%-0.9%;P<0.001),而在此期间药物洗脱支架内再狭窄患者的比例增加(5.4%-6.3%;P<0.001)。

与无支架内再狭窄PCI患者相比,接受支架内再狭窄PCI手术的患者不太可能出现non-STEMI(18.7% vs. 22.5%;P<0.001)或STEMI(8.5% vs. 15.7%;P<001)。在院内并发症和住院时间方面,两组在倾向匹配人群中无显着差异。

作者表示,虽然减少支架支撑厚度有助于改善支架置入后的效果,但我们很可能已经达到了这种方法的极限。研究应该集中在两个方面:进一步开发第二代生物可降解支架技术,能够在不损害机械性能的情况下使用更薄的支架梁制造支架,以及进行决定性的大型随机临床试验,以评估药物洗脱球囊治疗支架内再狭窄的疗效。

未来支架内再狭窄负担的潜在增长

德国慕尼黑Deutsches Herzzentrum科技大学心脏病学教授、心导管室主任Adnan Kastrati教授和介入性心脏病专家Salvatore Cassese教授在随刊发表的一篇社论中表示,尽管当代DES治疗在安全性和有效性方面都有了很大的提高,仍有相当比例的患者发生支架内再狭窄。鉴于DES疗法在世界范围内的广泛应用以及日常生活中冠心病治疗复杂性的增加,预示着与支架内再狭窄相关的疾病负担在未来几年将会增加。

原始出处:

Issam D. Moussa, Divyanshu Mohananey, Jorge Saucedo, et al.Trends and Outcomes of Restenosis After Coronary Stent Implantation in the United States.Journal of the American College of Cardiology.Volume 76, Issue 13, September 2020.DOI: 10.1016/j.jacc.2020.08.002.

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    2021-07-11 hbwxf
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1985873, encodeId=ac8519858e373, content=<a href='/topic/show?id=20605e09148' target=_blank style='color:#2F92EE;'>#支架内再狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57091, encryptionId=20605e09148, topicName=支架内再狭窄)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Mon Aug 23 23:02:56 CST 2021, time=2021-08-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854858, encodeId=e168185485885, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sun Jul 11 17:02:56 CST 2021, time=2021-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326707, encodeId=af7e1326e0719, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sat Sep 26 01:02:56 CST 2020, time=2020-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486215, encodeId=23b514862151a, content=<a href='/topic/show?id=15b93065283' target=_blank style='color:#2F92EE;'>#再狭窄#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30652, encryptionId=15b93065283, topicName=再狭窄)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bf8f8090913, createdName=12498f1em10(暂无昵称), createdTime=Sat Sep 26 01:02:56 CST 2020, time=2020-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=888213, encodeId=fd6588821303, content=不知道研究对象的地域,这篇文章对中国研究有没有帮助?, beContent=null, objectType=article, channel=null, level=null, likeNumber=95, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b58d5402080, createdName=咻凡, createdTime=Fri Sep 25 11:26:50 CST 2020, time=2020-09-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=887923, encodeId=024188e9236d, content=与支架内再狭窄相关的疾病负担在未来几年将会增加。, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ae205385871, createdName=Lexi, createdTime=Thu Sep 24 13:59:21 CST 2020, time=2020-09-24, status=1, ipAttribution=)]
    2020-09-25 咻凡

    不知道研究对象的地域,这篇文章对中国研究有没有帮助?

    0

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    2020-09-24 Lexi

    与支架内再狭窄相关的疾病负担在未来几年将会增加。

    0

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