Kupferwasser L Iri, Amorn Allen M, Kapoor Nikhil, Lee Michael S, Kar Saibal, Cercek Bojan, Dohad Suhail, Mirocha James, Forrester James S, Shah Prediman K, Makkar Raj R
Division of Cardiology, Cedars-Sinai Medical Center, University of California, Los Angeles School of Medicine, California 90048, USA.
Catheter Cardiovasc Interv. 2007 Jul 1;70(1):1-8. doi: 10.1002/ccd.21083.
The aim of this study was to compare the procedural characteristics and outcomes of patients with acute myocardial infarction treated with drug-eluting stents (DES) vs. bare metal stents (BMS).
DES have been shown to reduce the incidence of restenosis and target vessel revascularization (TVR) in clinical randomized studies when compared with BMS in patients undergoing elective percutaneous intervention. Limited data are available with the use of DES in patients with acute ST-segment elevation myocardial infarction.
Two hundred and sixty-one consecutive patients who presented with myocardial infarction between 7/2001 and 8/2005 were studied. The procedural characteristics, 30-day and 12-month outcomes of 131 patients treated with DES were compared with 130 patients treated with BMS.
At 12-months follow-up DES therapy was associated with a substantial decrease in major adverse cardiovascular events (MACE) (HR 0.33; P =0.002), TVR (HR 0.19; P =0.002), and recurrent myocardial infarction (HR 0.23; P =0.051) vs. BMS therapy. Coronary interventions utilizing DES were characterized by a marked increase in the number of stent per target vessel (DES: 1.9 +/- 0.9 vs. BMS: 1.38 +/- 0.6, P < 0.0001), treatment of bifurcation (DES: 21% vs. BMS: 5%, P =0.0004), and multivessel intervention (DES: 22% vs. BMS: 8%, P =0.003).
The routine use of DES in acute myocardial infarction is associated with reduced rates of MACE at 12 months vs BMS, despite a higher rate of complex procedures in the DES treated patients. In addition to its anti-restenosis effect, the improved outcome of patients treated with DES may be linked to a more complete revascularization in association with prolonged clopidogrel therapy.
本研究旨在比较接受药物洗脱支架（DES）与裸金属支架（BMS）治疗的急性心肌梗死患者的手术特征及预后。
临床随机研究表明，在接受择期经皮介入治疗的患者中，与BMS相比，DES可降低再狭窄和靶血管血运重建（TVR）的发生率。关于DES用于急性ST段抬高型心肌梗死患者的数据有限。
对2001年7月至2005年8月期间连续收治的261例心肌梗死患者进行研究。将131例接受DES治疗的患者与130例接受BMS治疗的患者的手术特征、30天及12个月的预后进行比较。
在12个月的随访中，与BMS治疗相比，DES治疗与主要不良心血管事件（MACE）（风险比0.33；P = 0.002）、TVR（风险比0.19；P = 0.002）及复发性心肌梗死（风险比0.23；P = 0.051）的大幅降低相关。使用DES进行冠状动脉介入治疗的特点是每个靶血管的支架数量显著增加（DES：1.9±0.9 vs. BMS：1.38±0.6，P < 0.0001）、分叉病变治疗（DES：21% vs. BMS：5%，P = 0.0004）及多支血管介入治疗（DES：22% vs. BMS：8%，P = 0.003）。
在急性心肌梗死中常规使用DES与12个月时MACE发生率低于BMS相关，尽管接受DES治疗的患者复杂手术率较高。除了其抗再狭窄作用外，接受DES治疗患者预后改善可能与更完全的血运重建及延长氯吡格雷治疗有关。
