Bose Rahul, Gupta Gaurav, Grayburn Paul A, Laible Emily A, Kang Mi Jung, Choi James W
Baylor University Medical Center, Dallas, Texas, USA.
Am J Cardiol. 2007 Sep 15;100(6):949-52. doi: 10.1016/j.amjcard.2007.04.030. Epub 2007 Jul 2.
Several trials have shown the effectiveness of drug-eluting stents (DES) in reducing restenosis. Acute ST-elevation myocardial infarction (STEMI) has been an exclusion criterion in most trials evaluating the safety and efficacy of DES. There is recent randomized trial data evaluating the use and safety of DES for acute myocardial infarction. However, there is a need for "real world" data on the efficacy and safety of DES in STEMI. A single-center retrospective analysis was performed on 188 consecutive patients with STEMI treated with primary or rescue coronary angioplasty between March 2004 and July 2005. The study consisted of 3 groups: 115 patients treated with paclitaxel-eluting stents, 55 with sirolimus-eluting stents, and 18 with bare metal stents. Outcomes were assessed from 12 to 28 months (mean 20, median 19) for major adverse cardiac events (MACEs) including myocardial infarction, in-stent thrombosis, clinical restenosis, and death. There were 4 in-stent thromboses in the paclitaxel group (3.4%) and 2 in-stent thromboses in the sirolimus group (3.6%). The thromboses ranged from acute (within 24 hours) to as late as 8 months. Clinical restenosis occurred in 4 patients (3.4%) in the paclitaxel group and in 2 patients (3.6%) in the sirolimus. None of the 18 patients with bare metal stents had thrombosis or clinical restenosis. There were 7 total deaths, all related to complications from the index STEMI: 1 in the bare metal group, 1 in the sirolimus group, and 5 in the paclitaxel group. The postdischarge MACE rate was 7% with no deaths. In conclusion, the use of DES in acute STEMI is associated with a low postdischarge MACE rate and a 3.5% in-stent thrombosis rate, which is similar to reported rates in earlier randomized trials.
多项试验已表明药物洗脱支架（DES）在降低再狭窄方面的有效性。在大多数评估DES安全性和有效性的试验中，急性ST段抬高型心肌梗死（STEMI）一直是排除标准。最近有随机试验数据评估了DES用于急性心肌梗死的情况。然而，需要关于DES在STEMI中疗效和安全性的“真实世界”数据。对2004年3月至2005年7月期间接受直接或补救性冠状动脉血管成形术治疗的188例连续STEMI患者进行了单中心回顾性分析。该研究包括3组：115例接受紫杉醇洗脱支架治疗的患者、55例接受西罗莫司洗脱支架治疗的患者和18例接受裸金属支架治疗的患者。对主要不良心脏事件（MACE）进行了12至28个月（平均20个月，中位数19个月）的评估，MACE包括心肌梗死、支架内血栓形成、临床再狭窄和死亡。紫杉醇组有4例支架内血栓形成（3.4%），西罗莫司组有2例支架内血栓形成（3.6%）。血栓形成时间从急性（24小时内）到最晚8个月不等。紫杉醇组有4例患者（3.4%）发生临床再狭窄，西罗莫司组有2例患者（3.6%）发生临床再狭窄。18例接受裸金属支架治疗的患者均未发生血栓形成或临床再狭窄。总共有7例死亡，均与首次STEMI的并发症相关：裸金属组1例，西罗莫司组1例，紫杉醇组5例。出院后MACE发生率为7%，无死亡病例。总之，在急性STEMI中使用DES与出院后低MACE发生率和3.5%的支架内血栓形成率相关，这与早期随机试验报告的发生率相似。
