| [Objective]:Percutaneous coronary intervention (PCI) had become one of the main therauputic approach for coronary artery disease, but the study of long-term outcomes in our center had not reported. This retrospective cohort study was designed to analyse the long term outcomes of PCI underwent in PUMC Hospital.[Methods]:All the patients who underwent PCI with implantation of either drug-eluting stent(DES) or bare-metal stent (BMS) in a single institute from January 2003 to December 2007, were included in the analysis.1945 patients were ultimately enrol led in this study, and all the statistics was calculated by SPSS13.0 for Windows.[Results]:All the patients mean age was 63.69±11.19ys, there were 1366 men; 615 patients were defined as ST elevation myocardial infarction (STEMI),795 patients were defined as non-ST elevation myocardial infarction(NSTEMI) or unstable angina(UA),535 patients were defined as stable angina(SA);98.1% patients had at least one risk factor. After coronary angiography, we found 760 patients had three-vessel diseases,613 patients had two-vessles diseases,572 patients had were single vessel disease. Altegether 3492 stents was implanted in all patients, mean 1.79 stents in each patient, the diameter of the stent was 3.01±0.4mm, the length of the stent was 21.99±7.2 mm, altogether 2445 DES were implanted,1047 BMS were implanted. In 2003,25.9% of patients were implanted with DES, the number was increased to 86.2% in 2007, the proportion of DES using in patients with stable angina was as high as 82.6%, the proportion of BMS using in patients with STEMI was as high as 49%. The length of hospital-stay of each patient was 10.35±8.33 days, medical cost was￥70878±35440, device cost wasY55745±39398.99.9% patients received dual antiplatelet medicine after PCI, other second prevention medicine of coronary artery disease was also regularly used.During follow-up of 34.98±19.63 months(1-83 months),268 (13.8%) patients reach end-point, all-cause mortality in 135 (6.9%)patients, cardiac mortality in 87 (4.5%) patients, infectious diseases mortality in 22 patien ts, tumor-relating mortality death in 19 patients, other reason death in other 7 patients;42 patients were defined stent thrombosis (ST), angiographic in-stent stenosis occurred in 459 patients (23.6%),86(8.2%) patients had implanted BMS, and 43(1.8%) patients had implanted DES,123 patients(6.3%) underwent target lesion revascularization (TLR), myocardial infarction occurred in 86 patients, and 63 of them were non-fatal myocardial infar ction. In STEMI patients,NSTEMI/UA patients,stable angina patients, the rates of death (9.3%vs6.7vs4.8%, p=0.011), the rates of cardiac death(8.1%vs3.3% vs2.0%, p=0.000), the rates of myocardial infaction (6.3%vs 4.4%vs2.2%, p=0.003), the rates of TLR (7.8% vs6.9%vs3.7%, p=0.012), the rates of ST (4.3%vs2.0%vs0.5%, p=0.001) were significantly different; All patients were divided into three group by implantating different stents:BMS group, DES group, BMS and DES group, the incidence of ST(2.04vs1.96% vs3.42%, p=0.506) were not sign ificantly different, but the incidence of death(13.1% vs4.1%vs 5.5%, p=0.000), cardiac death(9.7%vs 2.05%vs3.4%, p=0.000), TLR (9.2%vs 3.7%vs 16.4%, p=0.000) were significantly different. The cost-effectivess for preventing in-stent stenosis of is￥35705-50933 for BMS,￥51808-58421 for DES in differene year,the cost- effectivess for preventing ST of is￥5068 for BMS,￥10813/person for DES.[Conclusions]:Druing long term follow-up, acute coronary syndrome patients had high rate of death, cardiac death, myocardial infarction, TLR,ST than SA patients, DES can significantly decrease rates of death (including cardiac death), in-stent stenosis and TLR, without increasing rates of ST. The cost-effectiveness for preventing in-stent stenosis and ST with DES was higher than with BMS. |
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