チロスタゾールで治療された患者における冠動脈ステントレステノシス
John S Douglas1, David R Holmes, Dean J Kereiakes
1Emory University School of Medicine, Atlanta, GA, USA. john_douglas@emoryhealthcare.org
Circulation
|October 26, 2005
まとめ
シロスタゾールは,冠動脈ステントを設置した後のレステノシスを著しく減少させ,最小光径を改善しました. この薬は,特に高リスクの患者にとって,有害事象を増加させることなく有効です.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
- 介入性心臓病学 介入性心臓病学
背景:
- 冠動脈ステントの回復は,主要な臨床的課題です.
- ステントを設置した後のインティマルの増殖は,再成長につながります.
- ステント後のレステノシスを予防するために,新しい治療戦略が必要である.
研究 の 目的:
- 冠動脈ステントの植え付け後のレステノシスの軽減におけるシロスタゾールの有効性を評価する.
- チロスタゾールの最小光径と二次レステノシス率に対する影響を評価する.
- チロスタゾール治療から最も恩恵を受ける患者のサブグループを特定する.
主な方法:
- 705人の患者が参加したランダム化,ダブルブラインド,プラセボ対照試験です.
- 患者はアスピリン,シロスタゾール (100 mg BID) またはプラセボを6ヶ月間,そしてクロピドグレルを30日間投与された.
- 定量冠動脈動脈造影は,6ヶ月でレステノスを評価するために使用されました.
主要な成果:
- シロスタゾール治療は,より大きな最小光直径 (1.77mm対1.62mm,P=0.01) をもたらしました.
- バイナリ・レステノシスは,チロスタゾール患者の22.0%で,プラセボ患者の34.5%で発生しました (P=0.002),相対リスクの減少36%.
- 糖尿病患者,小血管,長い病変の患者,左前下垂動脈ステントの患者で有意な効果が観察されました.
結論:
- シロスタゾールは,バイナリ・レステノシス率を著しく低下させ,ステントの施術後のルミナル直径を改善します.
- この薬は,高リスクの患者集団において特に有効性を示しています.
- シロスタゾールは出血,再入院,心筋梗塞,または死亡率を増加させませんでした.
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