COMPARATIVE RESULTS OF DRUG-ELUTING AND CARBONIC STENTS APPLICATION FOR TREATMENT OF PATIENTS WITH ALL FORMS OF ACUTE CORONARY SYNDROME IN A LONG-TERM FOLLOW-UP PERIOD

Purpose. To study the clinical efficiency and safety of application of drug-eluting and carbonic stents in patients with different forms of acute coronary syndrome in a long-term follow-up period.

Materials and methods. The study enrolled 600 patients with acute coronary syndrome (STEMI – 197 patients; nonSTEMI – 208 patients; unstable angina – 195 patients). Clinical outcomes of interventions in patients enrolled into the study were evaluated prospectively after 12 months.

Results. Intergroup analyses of long-term results of implantation of sirolimus-eluting stents, everolimus-eluting stents with stents with modified carbon surface showed a significant difference in the incidence of restenosis and repeat revascularization in favour of drug-eluting stents (р < 0,05 in all the groups by indicators of repeat revascularization and restenosis incidence for each drug). The fatality rate both from cardiac and other reasons didn’t differ among groups of patients. Intravascular ultrasound test demonstrated the advantage of sirolimuseluting stents over carbonic stents by the indicator of late lumen loss (STEMI – 0,20 mm vs. 0,65 mm; nonSTEMI – 0,22 mm vs. 0,67 mm; unstable angina – 0,20 mm vs. 0,65 mm, р < 0,05); and the advantage of everolimus-eluting stents by this indicator (STEMI – 0,16 mm vs. 0,65 mm, nonSTEMI – 0,16 mm vs. 0,67 mm, unstable angina – 0,18 mm vs. 0,65 mm, р < 0,05).

Conclusions. On the basis of the performed analyses the present study demonstrated a high clinical efficiency and safety of application of drug-eluting and carbonic stents in patients with different forms of acute coronary syndrome in a long-term follow-up period.

1. Снижение госпитальной летальности у больных с острым инфарктом миокарда / Д. Г. Иоселиани [и др.] // Международный журнал интервенционной кардиоангиологии. 2003. № 3. С. 21.

2. Abciximab-Supported Infarct Artery Stent Implantation for Acute Myocardial Infarction and Long-Term Survival. A Prospective, Multicenter, Randomized Trial Comparing Infarct Artery Stenting Plus Abciximab With Stenting Alone / D. Antoniucci [et al.] // Circulation. 2004. Vol. 109. P. 1704–1706.

3. Auerbach D. (RAND), Maeda J. (Thomson Reuters) and Steiner C. (AHRQ) / Hospital Stays with Cardiac Stents, 2009 // HCUP Statistical Brief 128. April 2012. Agency for Healthcare Research and Quality. Rockville, MD. Режим доступа: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb128.pdf (дата обращения: 02.02.2011).

4. Bartorelli A. L., Trabattoni D., Montorsi P. Aspirin alone antiplatelet regimen after intracoronary placement of the Carbostent: the ANTARES study // Catheter Cardiovasc. Interv. 2002. Vol. 55. P. 150–156.

5. Braun P. Prospective randomized study of the restenotic process in small coronary arteries using a Carbofilm coated stent in comparison with plain old balloon angioplasty: a multicenter study // Catheter Cardiovasc. Interv. 2007. Vol. 70, № 7. Р. 920–927.

6. Improved short-term outcomes of primary stenting compared to primary angioplasty in acute myocardial infarction: the PAMI stent pilot trial / G. W. Stone [et al.] // Circulation. 1997. Vol. 96 (suppl I). P. 594.

7. Meta-analysis of clinical trials on use of drug-eluting stents for treatment of acute myocardial infarction / V. Pasceri [et al.] // Am. Heart J. 2007. Vol. 153, № 5. Р. 749–754.

8. Nakazawa G., Finn A. V., Joner M. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study // Circulation. 2008. Vol. 118. P. 1138–1145.

9. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endoth- elialization / A. V. Finn [et al.] // Circulation. 2007. Vol. 115. P. 2435–2441.

10. Serial long-term evaluation of neointimal stent coverage and thrombus after sirolimus-eluting stent implantation by use of coronary angioscopy / M. Takano [et al] // Heart. 2007. Vol. 93. P. 1353–1356.

11. Six-month clinical and angiographic follow-up after direct angioplasty for acute miocardial infarction: final results from the primary angioplasty registry / R. R. Brodie [et al.] // Ibid. 1994. Vol. 90. P. 156–162.

12. Shuchman M. Trading restenosis for thrombosis? New questions about drug-eluting stents // N. Engl. J. Med. 2006. Vol. 355. P. 1949–1952.

13. Turpie A. G. Burden of disease: medical and economic impact of acute coronary syndromes. // Am. J. Manag. Care. 2006. Vol. 12 (suppl 16). P. 430–434.