糖尿病における小血管に対するシロリムス溶出性冠動脈ステントの有効性に関する検討 : 多施設前向きレジストリーからの解析

概要

論文の詳細を見る
The Heart Institute of Japan Cardiology Drug-Eluting Stent Registry (HIJ-DESR) is a multi-center, prospective, observational cohort to assess safety and efficacy of sirolimus-eluting stents (SESs) in routine clinical practice. By the end of March 2007, follow-up angiography had been completed for 1,294 consecutive patients (1,843 lesions). Mean age of studied patients was 67 ± 10 years old and 78% was male gender. Based on reference vessel size (cut-off, 2.5mm) and the presence of diabetes, clinical outcomes were evaluated in terms of need for subsequent target lesion revascularization (TLR) during follow-up and quantitative coronary angiography (QCA) data at a median of 11.2 months. QCA-derived in-stent restenosis (ISR) increased in frequency from 3.8% for diabetic large vessels to 4.8% for non-diabetic small vessels, and to 13.8% for small vessels of diabetic patients. Likewise, Rate of TLR following DES implanted in non-diabetic large (≧2.5mm) vessels was as low as 1.4%, increasing to 3.9% with diabetes (hazard ratio (HR), 2.38; 95% confidence interval (CI), 1.14-4.97; p=0.021), and to 6.7% with diabetic small (<2.5mm) vessels (HR, 3.85; 95% CI, 1.80-8.24; p<0.001). Small vessel size plus diabetes thus displayed additive associations with deteriorated clinical and angiographical outcomes. However, a TLR rate of 6.7% seems quite acceptable.
東京女子医科大学の論文