Mortality Risk Following Application of a Paclitaxel-Coated Stent in Femoropopliteal Lesions

被引:15
作者
Katsuki, Tomonori [1 ]
Takahara, Mitsuyoshi [2 ]
Soga, Yoshimitsu [1 ]
Okamoto, Shin [3 ]
Iida, Osamu [3 ]
Fujihara, Masahiko [4 ]
Kawasaki, Daizo [5 ]
Ando, Kenji [1 ]
机构
[1] Kokura Mem Hosp, Dept Cardiol, Kitakyushu, Fukuoka, Japan
[2] Osaka Univ, Dept Diabet Care Med, Grad Sch Med, Suita, Osaka, Japan
[3] Kansai Rosai Hosp, Dept Cardiol, Amagasaki, Hyogo, Japan
[4] Kishiwada Tokushukai Hosp, Dept Cardiol, Osaka, Japan
[5] Morinomiya Hosp, Dept Internal Med, Cardiovasc Div, Osaka, Japan
关键词
Drug-coated stent; drug-eluting stent; dose dependency; endovascular therapy; femoropopliteal segment; mortality; paclitaxel; stenosis; ELUTING STENTS; BALLOON; TRIAL;
D O I
10.1177/1526602819870309
中图分类号
R61 [外科手术学];
学科分类号
摘要
Purpose: To examine if endovascular therapy (EVT) with paclitaxel-coated stents increases the mortality risk in patients with symptomatic lower limb peripheral artery disease (PAD). Materials and Methods: A retrospective analysis was conducted of paclitaxel-coated stent use in the femoropopliteal segment of 1535 symptomatic (Rutherford category 2 to 4) patients treated between January 2010 and December 2016 at 4 hospitals in Japan. The risk of all-cause mortality was examined between the 285 patients (mean age 73 +/- 8 years; 213 men) treated with a paclitaxel-coated stent (PTX-coated group) and 1250 patients (mean age 73 +/- 9 years; 872 men) not exposed to a paclitaxel-coated device (PTX-free group) during EVT. Propensity score matching was employed to balance baseline characteristics. Cox proportional hazards models stratified on the quintiles of the propensity score were used to investigate paclitaxel-coated stent use and mortality risk as well as interactions among baseline variables and the main outcome. Interactions between a PXT-coated stent and subgroups of the PTX-free group (bare stent and angioplasty) were also investigated, as was the impact of paclitaxel dose on mortality risk. The results of regression analysis are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 3-year overall survival estimates were 86.4% in the PTX-coated group vs 87.7% in the PTX-free group; the corresponding 5-year estimates were 77.5% vs 73.7%, respectively. There was no significant difference in all-cause mortality between the 2 groups (HR 0.89, 95% CI 0.66 to 1.19, p=0.41). The cause of death also showed no remarkable difference between the groups. Chronic renal failure (p=0.044) and arterial calcification (p=0.022) demonstrated a significant interaction effect on the association of the use of a PTX-coated stent with all-cause mortality. No subgroup demonstrated that the use of a paclitaxel-coated stent was associated with an increased risk of all-cause mortality. A dose dependency was not evident. Conclusion: Mortality risk following application of a PTX-coated stent did not increase over 5 years, irrespective of the dose. A PTX-coated stent for femoropopliteal lesions in PAD patients is a safe treatment option.
引用
收藏
页码:593 / 599
页数:7
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