International Circulation: There have been some recent randomized clinical trials that have shown the incidence of stent thrombosis did not differ significantly for patients with drug-eluting stents and those with bare metal stents. What is your opinion as to that outcome?
国际循环:最近的一些临床随机试验表明药物洗脱支架与金属裸支架的支架内血栓发生率并无明显差异。您对这一结果有何意见?
International Circulation: There have been some recent randomized clinical trials that have shown the incidence of stent thrombosis did not differ significantly for patients with drug-eluting stents and those with bare metal stents. What is your opinion as to that outcome?
国际循环:最近的一些临床随机试验表明药物洗脱支架与金属裸支架的支架内血栓发生率并无明显差异。您对这一结果有何意见?
Prof. Bruce Brodie: I think the main limitation in most of those trials is that they have had a rather short-term follow-up out to one or maybe two years. In randomized trials comparing bare metal and drug-eluting stents out to 1-2 years there is just now difference between the two. The real question we have is whether there might be a great incidence of stent thrombosis with drug eluting stents in later years. One reason to think that might happen is that there is a higher incidence of malaposition of drug-eluting stents compared to bare metal stents 9-12 months after implantation for a stemi, as measured by intravascular ultrasound. Malaposition has been one thing that has been associated with late stent thrombosis. So far all the clinical data do not show any differenct between drug-eluting stents and bare metal stents out to 1-2 years.
Prof. Bruce Brodie: 我认为在这些试验中最主要的局限是它们的随访时间比较短,都在一或两年。比较裸支架和药物洗脱支架的随机试验随访1〜2年,两者之间并无差异。而真正的问题是,在以后的几年内药物洗脱支架的支架内血栓发生率是否更高。有理由相信这是可能发生的,因为通过血管内超声检测发现,急性ST段抬高性心梗支架植入后9~12个月,药物洗脱支架的贴壁不良发生率高于金属裸支架。贴壁不良与晚期支架内血栓形成有关。到目前为止,没有临床资料表明在1-2年药物洗脱支架和金属裸支架之间有显著差别。
International Circulation: To your knowledge are there any longer term studies planned to address this?
国际循环:据您所知关于这方面有否更长期的研究?
Prof. Bruce Brodie: The HORIZONS trial will go out 5 years. The two year results of HORIZONS with transamiza (?) compared to bare metal stents in stemi patients, those two year results should be presented later this week.
Prof. Bruce Brodie: HORIZONS试验将持续5年。HORIZONS研究中有关急性心梗患者植入药物洗脱支架与金属裸支架相比的两年随访研究,这项研究结果即将公布。