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糖尿病患者使用Cypher支架的風險

張貼者:2009年8月24日 下午7:43Dr. Chu   [ 已更新 2009年8月24日 下午8:19 ]
國內常使用的藥物塗層支架Cypher(SES,sirolimus-eluting stents)
在今年9月1日的JACC雜誌的統合分析(Meta-Analysis)中顯示,經過五年追蹤,
安全性和一般支架相當但是減少近一半的再狹窄的機會。
Late stent thrombosis:more frequently in BMS during the first year (0.2% for SES vs. 0.9% for BMS).
Very late stent thrombosis:similar between the SES and BMS groups
The annual rate of definite or probable stent thrombosis for years 1 through 5 was low for both groups and did not differ between them (0.4% for SES vs. 0.2% for BMS per year)
不過在糖尿病的族群,可能有較高的死亡率的風險,
  • 心因性死亡以及心肌梗塞獨立預測因子
  • Smoking (HR 1.85)
  • Congestive heart failure (HR 1.79)
  • Diabetes (HR 1.37)
  • Older age (HR 1.05)
  • Number of stents implanted (HR 1.02).
  • 但是可顯著減少再狹窄率,支架血栓機率相當。
  • Significantly higher rates of all-cause and cardiac death and Q-wave MI(p value 0.03, 0.04, 0.03) 
    SES:highly effective in reducing TVR
           stent thrombosis was similar for both stent types
    ==> 因為Study Underpowered,抗血小版藥物服用以及糖尿病患者過少問題, 這些結論還需要更多資料證實
     
    作者/期刊
    Caixeta A, Leon MB, Lansky AJ, et al. 5-year clinical outcomes after sirolimus-eluting stent implantation. Insights from a patient-level pooled analysis of 4 randomized trials comparing sirolimus-eluting stents with bare-metal stents. J Am Coll Cardiol. 2009;54:894-902.
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