Daemen Joost, Tanimoto Shuzou, García-García Héctor M, Kukreja Neville, van de Sande Meike, Sianos Georgios, de Jaegere Peter P T, van Domburg Ron T, Serruys Patrick W
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2007 Apr 15;99(8):1027-32. doi: 10.1016/j.amjcard.2006.11.070. Epub 2007 Mar 6.
Sirolimus-eluting stents (SESs) recently proved to be superior to bare metal stents (BMSs) in decreasing the need for repeat revascularization in patients with ST-segment elevation myocardial infarction (STEMI) at 1 year. Whether this also holds for paclitaxel-eluting stents (PESs) is currently unclear and the long-term relatively efficacy of the 2 drug-eluting stents is currently unknown. We investigated the 3-year efficacy of SESs and PESs versus BMSs in patients with STEMI. Primary angioplasty was performed in a consecutive group of 505 patients (BMSs in 183, SESs in 186, PESs in 136). At 3 years, the cumulative mortality rate was comparable in the 3 groups: 13.3% in the BMS group, 11.5% in the SES group, and 12.4% in the PES group (nonsignificant for all). The rate of target vessel revascularization (TVR) was 12.0% in the BMS group compared with 8.0% and 7.7% in the SES and PES groups, respectively (p = 0.12 for BMS vs SES, 0.30 for BMS vs PES, 0.62 for SES vs PES). The cumulative incidence of death, MI, or TVR was 25.5% in the BMS group compared with 17.9% and 20.6% in the SES and PES groups, respectively (p = 0.06 for BMS vs SES, 0.32 for BMS vs PES, 0.45 for SES vs PES). Angiographic stent thrombosis occurred in 2.4% of all patients (BMS 1.6%, SES 2.7%, PES 2.9%). In conclusion, in this relatively small consecutive patient cohort, the use of SESs and PESs was no longer associated with significantly lower rates of TVR and major adverse cardiace events in patients with STEMI after 3 years of follow-up. A high frequency of stent thrombosis was observed in the 2 drug-eluting stent groups.
西罗莫司洗脱支架（SES）最近被证明在降低ST段抬高型心肌梗死（STEMI）患者1年时再次血管重建需求方面优于裸金属支架（BMS）。紫杉醇洗脱支架（PES）是否也如此目前尚不清楚，且这两种药物洗脱支架的长期相对疗效目前也未知。我们研究了SES和PES与BMS相比在STEMI患者中的3年疗效。对连续的505例患者进行了直接血管成形术（183例植入BMS，186例植入SES，136例植入PES）。3年时，3组的累积死亡率相当：BMS组为13.3%，SES组为11.5%，PES组为12.4%（均无统计学意义）。BMS组的靶血管重建（TVR）率为12.0%，而SES组和PES组分别为8.0%和7.7%（BMS与SES相比，p = 0.12；BMS与PES相比，p = 0.30；SES与PES相比，p = 0.62）。BMS组死亡、心肌梗死或TVR的累积发生率为25.5%，而SES组和PES组分别为17.9%和20.6%（BMS与SES相比，p = 0.06；BMS与PES相比，p = 0.32；SES与PES相比，p = 0.45）。所有患者中血管造影显示的支架血栓形成发生率为2.4%（BMS为1.6%，SES为2.7%，PES为2.9%）。总之，在这个相对较小的连续患者队列中，随访3年后，STEMI患者使用SES和PES不再与显著更低的TVR率和主要不良心脏事件相关。在两个药物洗脱支架组中观察到较高频率的支架血栓形成。
