Suryapranata H, Ottervanger J P, Nibbering E, van 't Hof A W, Hoorntje J C, de Boer M J, Al M J, Zijlstra F
Department of Cardiology, Isala Klinieken, Hospital de Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, Netherlands.
Heart. 2001 Jun;85(6):667-71. doi: 10.1136/heart.85.6.667.
To investigate the long term clinical outcome and cost-effectiveness of stenting compared with balloon angioplasty in patients with acute myocardial infarction.
Patients with acute myocardial infarction were randomly allocated to primary stenting (112) or balloon angioplasty (115). The primary end point was the cumulative first event rate of death, non-fatal reinfarction, or target vessel revascularisation. Secondary end points were restenosis at six months and the cost-effectiveness at follow up.
After 24 months, the combined clinical end point of death/reinfarction was 4% after stenting and 11% after balloon angioplasty (p = 0.04). Subsequent target vessel revascularisation was necessary in 15 patients (13%) after stenting and in 39 (34%) after balloon angioplasty (p < 0.001). The cumulative cardiac event-free survival rate was also higher after stenting (84% v 62%, p < 0.001). The angiographic restenosis rate after stenting was less than after balloon angioplasty (12% v 34%, p < 0.001). Despite the higher initial costs of stenting (Dfl 21 484 v Dfl 18 625, p < 0.001), the cumulative costs at 24 months were comparable with those of balloon angioplasty (Dfl 31 423 v Dfl 32 933, p = 0.83).
Compared with balloon angioplasty, primary stenting for acute myocardial infarction results in a better long term clinical outcome without increased cost.
研究急性心肌梗死患者中，支架置入术与球囊血管成形术相比的长期临床疗效及成本效益。
将急性心肌梗死患者随机分为直接支架置入组（112例）和球囊血管成形术组（115例）。主要终点是死亡、非致死性再梗死或靶血管血运重建的累积首次事件发生率。次要终点是6个月时的再狭窄情况及随访时的成本效益。
24个月后，支架置入术后死亡/再梗死的联合临床终点为4%，球囊血管成形术后为11%（p = 0.04）。支架置入术后15例患者（13%）需要进行后续靶血管血运重建，球囊血管成形术后为39例（34%）（p < 0.001）。支架置入术后无心脏事件生存率也更高（84%对62%，p < 0.001）。支架置入术后血管造影再狭窄率低于球囊血管成形术（12%对34%，p < 0.001）。尽管支架置入术初始成本较高（21484荷兰盾对18625荷兰盾，p < 0.001），但24个月时的累积成本与球囊血管成形术相当（31423荷兰盾对32933荷兰盾，p = 0.83）。
与球囊血管成形术相比，急性心肌梗死直接支架置入术可带来更好的长期临床疗效且成本未增加。
