Newell Marc C, Henry Christopher R, Sigakis Christopher J G, Unger Barbara Tate, Larson David M, Chavez Ivan J, Burke M Nicholas, Traverse Jay H, Henry Timothy D
Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, USA.
Am J Cardiol. 2006 May 1;97(9):1299-302. doi: 10.1016/j.amjcard.2005.11.054. Epub 2006 Mar 10.
Sirolimus-eluting stents (SESs) are superior to bare metal stents (BMSs) for percutaneous coronary intervention, but data regarding SESs in ST-segment elevation myocardial infarction (STEMI) are limited. We investigated the clinical outcomes of patients with STEMI who were treated with SESs. We measured clinical characteristics and acute and long-term outcomes in 306 consecutive patients with STEMI who received a SES (n = 156) or a BMS (n = 150). Patients were followed for death, nonfatal reinfarction, and target vessel revascularization. Patients with SESs had a 0.6% in-hospital mortality rate versus 5.3% in patients with BMSs (p = 0.015). Six-month mortality rates were 1.9% (SES) and 10.1% (BMS, p = 0.003). At 6 months, patients with SESs were less likely to have target vessel revascularization (1.3% vs 8.1%, p = 0.005) and achieve the composite end point (3.2% vs 16.1%, p = 0.0001). No subacute thrombosis or clinical restenosis occurred in the SES group. Patients who received BMSs were older, received more stents, and had more myocardial damage, worse renal function, and lower ejection fractions than did those in the SES group. By multivariate discriminant analysis, stent type (SES vs BMS) was the most significant determinant of the 6-month composite end point (p = 0.01) and the need for target vessel revascularization (p = 0.02). In conclusion, SESs are safe and effective in STEMI at 6 months.
雷帕霉素洗脱支架（SES）在经皮冠状动脉介入治疗方面优于裸金属支架（BMS），但关于SES在ST段抬高型心肌梗死（STEMI）中的数据有限。我们调查了接受SES治疗的STEMI患者的临床结局。我们测量了306例连续接受SES（n = 156）或BMS（n = 150）治疗的STEMI患者的临床特征以及急性和长期结局。对患者进行死亡、非致命性再梗死和靶血管血运重建情况的随访。接受SES的患者院内死亡率为0.6%，而接受BMS的患者为5.3%（p = 0.015）。6个月死亡率分别为1.9%（SES）和10.1%（BMS，p = 0.003）。在6个月时，接受SES的患者发生靶血管血运重建的可能性较小（1.3%对8.1%，p = 0.005），且达到复合终点的可能性较小（3.2%对16.1%，p = 0.0001）。SES组未发生亚急性血栓形成或临床再狭窄。接受BMS的患者比接受SES的患者年龄更大，植入的支架更多，心肌损伤更严重，肾功能更差，射血分数更低。通过多变量判别分析，支架类型（SES与BMS）是6个月复合终点（p = 0.01）和靶血管血运重建需求（p = 0.02）的最显著决定因素。总之，SES在STEMI患者6个月时是安全有效的。
