Kastrati Adnan, Dibra Alban, Spaulding Christian, Laarman Gerrit J, Menichelli Maurizio, Valgimigli Marco, Di Lorenzo Emilio, Kaiser Christoph, Tierala Ilkka, Mehilli Julinda, Seyfarth Melchior, Varenne Olivier, Dirksen Maurits T, Percoco Gianfranco, Varricchio Attilio, Pittl Undine, Syvänne Mikko, Suttorp Maarten J, Violini Roberto, Schömig Albert
Deutsches Herzzentrum, Technische Universität, Lazarettstr.36, Munich 80636, Germany.
Eur Heart J. 2007 Nov;28(22):2706-13. doi: 10.1093/eurheartj/ehm402. Epub 2007 Sep 27.
To compare the efficacy and safety of drug-eluting stents vs. bare-metal stents in patients with acute ST-segment elevation myocardial infarction.
We performed a meta-analysis of eight randomized trials comparing drug-eluting stents (sirolimus-eluting or paclitaxel-eluting stents) with bare-metal stents in 2786 patients with acute ST-segment elevation myocardial infarction. All patients were followed up for a mean of 12.0-24.2 months. Individual data were available for seven trials with 2476 patients. The primary efficacy endpoint was the need for reintervention (target lesion revascularization). The primary safety endpoint was stent thrombosis. Other outcomes of interest were death and recurrent myocardial infarction. Drug-eluting stents significantly reduced the risk of reintervention, hazard ratio of 0.38 (95% CI, 0.29-0.50), P < 0.001. The overall risk of stent thrombosis: hazard ratio of 0.80 (95% CI, 0.46-1.39), P = 0.43; death: hazard ratio of 0.76 (95% CI, 0.53-1.10), P = 0.14; and recurrent myocardial infarction: hazard ratio of 0.72 (95% CI, 0.48-1.08, P = 0.11) was not significantly different for patients receiving drug-eluting stents vs. bare-metal stents.
The use of drug-eluting stents in patients with acute ST-segment elevation myocardial infarction is safe and improves clinical outcomes by reducing the risk of reintervention compared with bare-metal stents.
比较药物洗脱支架与裸金属支架在急性ST段抬高型心肌梗死患者中的疗效和安全性。
我们对八项随机试验进行了荟萃分析，比较了药物洗脱支架（西罗莫司洗脱支架或紫杉醇洗脱支架）与裸金属支架在2786例急性ST段抬高型心肌梗死患者中的应用。所有患者平均随访12.0 - 24.2个月。七项试验的2476例患者有个体数据。主要疗效终点是再次干预的必要性（靶病变血运重建）。主要安全终点是支架血栓形成。其他感兴趣的结局是死亡和复发性心肌梗死。药物洗脱支架显著降低了再次干预的风险，风险比为0.38（95%可信区间，0.29 - 0.50），P < 0.001。支架血栓形成的总体风险：风险比为0.80（95%可信区间，0.46 - 1.39），P = 0.43；死亡：风险比为0.76（95%可信区间，0.53 - 1.10），P = 0.14；复发性心肌梗死：风险比为0.72（95%可信区间，0.48 - 1.08），P = 0.11，接受药物洗脱支架与裸金属支架的患者之间无显著差异。
在急性ST段抬高型心肌梗死患者中使用药物洗脱支架是安全的，与裸金属支架相比，通过降低再次干预的风险改善了临床结局。
