背景:尽管覆膜支架(CS)代表了冠状动脉穿孔(CAP)的潜在挽救生命的干预措施,他们的应用已经扩展到其他环境,包括冠状动脉瘤(CAA)。然而,在这些情况下,关于CS的中长期结果的数据仍然有限。
目的:本荟萃分析旨在评估使用新一代聚氨酯覆盖的钴铬PK纸莎草CS进行经皮冠状动脉介入治疗的患者因出院而长期随访的主要不良心脏事件(MACE)。
方法:我们对三项观察性试验的数据进行了荟萃分析,其中包括接受PKPapyrusCS植入的患者的长期随访:Papyrus-Spain,SOSPK纸莎草,和PAST-PERF注册表。
结果:332例患者接受了PK纸莎草CS植入,236(71.1%)用于CAP,CAA为70(21.1%),其他适应症为26(7.8%)。经过平均16.2个月的随访,MACE为14.3%,目标病变血运重建(TLR)是最常见的(8.5%),其次是支架血栓形成(ST),3.3%和心脏死亡(CD),2.6%。比较CAP和CAA亚组,CAA的MACE发生率明显高于CAP(21.4%vs9.7%,p<0.01),主要由ST驱动(CAA:8.6%vsCAP:1.3%;p=0.0015)。
结论:PK纸莎草CS植入后的临床结果被认为是可以接受的,考虑到具有挑战性的情况和现有的替代疗法。然而,接受PapyrusPKCS的CAA患者的MACE发生率明显高于CAP患者,强调在这些复杂的患者和冠状动脉解剖中精心选择和优化CS的重要性。
BACKGROUND: Although covered stents (CS) represent a potentially life-saving intervention for coronary perforation (CAP), their application has expanded to other contexts, including coronary aneurysms (CAA). However, data regarding mid- and long-term outcomes of CS in these settings scenarios remains limited.
OBJECTIVE: This meta-analysis aims to evaluate major adverse cardiac events (MACE) from discharge through long-term follow-up in patients undergoing percutaneous coronary intervention with the new generation polyurethane-covered cobalt-chromium PK Papyrus CS.
METHODS: We conducted a meta-analysis of data from three observational trials that included long-term follow-up of patients who underwent PK Papyrus CS implantation: Papyrus-Spain, SOS PK Papyrus, and PAST-PERF registry.
RESULTS: 332 patients underwent PK Papyrus CS implantation, 236 (71.1%) for CAP, 70 (21.1%) for CAA and 26 (7.8%) for other indications. After a mean follow-up of 16.2 months, the MACE was 14.3%, with Target Lesion Revascularization (TLR) being the most frequent (8.5%), followed by stent thrombosis (ST), 3.3% and cardiac death (CD), 2.6%. Comparing CAP and CAA subgroups, the MACE rate in CAA was significantly higher than CAP (21.4% vs 9.7%, p < 0.01), primary driven by ST (CAA: 8.6% vs CAP: 1.3%; p = 0.0015).
CONCLUSIONS: The clinical outcomes following PK Papyrus CS implantation are deemed acceptable, considering the challenging scenarios and the existing alternative treatments. However, MACE rates in patients with CAA who received Papyrus PK CS were significantly higher than in those with CAP, underscoring the importance of meticulous patient selection and optimization of CS in these complex patients and coronary anatomies.