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Coronary Stents
THE JOURNAL OF MEDICINE FOR THE WORLDWIDE MED COMMUNITY
Коронарные стенты
follow-up, a greater absolute
difference in cardiac death,
myocardial infarction, TLR, and
major adverse cardiac events
(MACE) was observed in
favour of EES, when compared
with results at both 1- and
2-year follow-up [31]. Similarly,
in the larger SPIRIT III trial,
the benefit of EES over PES
persisted and even increased
during follow-up; at 3 years,
EES eventually lead to significant
reduction in target vessel
failure (TVF), target lesion
failure (TLF), and MACE [31]
On aggregate SPIRIT I-III have
established superiority of EES
over PES with respect to angiographic
findings in low-risk profile
patients. However, these
trials were not powered for superiority
in clinical end points.
The SPIRIT IV trial assigned
3,687 patients to receive EES
(n=2,458) or PES (n=1,229)
[36]. The principal findings
revealed that EES resulted in a
significant 38% relative reduction
in the primary endpoint of
TLF versus PES, and significant
reduction in secondary
end points of stent thombosis
and myocardial infarction, but
with no significant difference
in mortality [36,37]. Similar
results were obtained in the
all-comers COMPARE trial. The
primary endpoint was a composite
of safety and efficacy
within 12 months [33,34] (Table
3). The composite of death,
myocardial infarction and target
vessel revascularization was
lower with EES thanwith PES
(6.2% vs. 9.1%; HR=0.69;
95% CI 0.50-0.95) driven by
a significant reduction of both
TVR (6.0% vs. 2.4%; p=0.001)
and myocardial infarction (5.4%
vs. 2.8%; p=0.007). The rate
of definite and probable stent
thrombosis was significantly
reduced among EES treated
patients (0.7% vs. 2.6%;
HR=0.26; 95%CI 0.11-0.64;
p=0.002). The significant difference
in stent thrombosis at
12 months between the two
groups was mainly attributable
to early stent thrombosis.
3. ZES versus EES
In ESTROFA-2 de la Torre
Hernandez et al analyzed 4,768
patients treated with ZES
(n=2,549) or EES (n=2,219);
the cumulative incidence of
definite/probable stent thrombosis
for ZES was 1.3% at
1 year and 1.7% at 2 years
and for EES 1.4% at 1 year
and 1.7% at 2 years (p=0.8),
respectively [38|. Increments of
definite thormbosis between
the first and second year was
0.2% and 0.25%, respectively.
Ejection fraction (HR 0.97; 95%
CI 0.95-0.99; p=0.008), stent
diameter (HR 0.37; 95% CI
0.17-0.81; p=0.01) and bifurcations
(HR 2.1; 95% CI 1.14-3.7;
p=0.02) emerged as predictors
of thrombosis [38]. Serruys et
убывающей следуют ЗВС(30,2 ±
14,2%), ПВС (26,8 ± 15,8%), а СВС
(6,4 ± 4,2%) (р