De Luca Giuseppe, Suryapranata Harry, van't Hof Arnoud W J, Ottervanger Jan Paul, Hoorntje Jan C A, Dambrink Jan-Henk, Gosselink A T Marcel, de Boer Menko-Jan
Division of Cardiology and Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA), Eastern Piedmont University, Novara, Italy.
J Cardiovasc Med (Hagerstown). 2009 Jan;10(1):22-6. doi: 10.2459/JCM.0b013e32830a48d2.
Primary angioplasty has been shown to improve the outcome in selected patients with ST-segment elevation myocardial infarction. However, no data have been reported of patients with proximal left anterior descending artery occlusion. In the Zwolle-6 randomized trial, a total of 1683 consecutive patients with ST-segment elevation myocardial infarction were randomized to stenting or balloon angioplasty without any exclusion criteria. The aim of this substudy was to investigate the benefits of coronary stenting as compared to balloon angioplasty in patients with proximal left anterior descending artery occlusion.
From April 1997 to October 2001, among a total of 1683 consecutive patients with ST-segment elevation myocardial infarction randomized to stenting or balloon angioplasty before the initial angiography, a total of 218 patients underwent primary angioplasty of proximal left anterior descending artery occlusion. One-year follow-up data were available from all patients.
A total of 107 patients were randomized to stent and 111 patients to balloon angioplasty. The cross-over rates from balloon to stent and stent to balloon were 35.1 and 13.1%, respectively (P<0.0001). The groups were comparable in terms of postprocedural thrombolysis in myocardial infarction flow, myocardial blush grade, distal embolization, and ST-segment resolution. Stenting was associated with benefits in terms of restenosis (27.6 vs. 53.8%, P=0.03) and target vessel revascularization (15.0 vs. 24.3%, P=0.081), whereas no difference was observed in mortality (11.2 vs. 13.5%, P>0.1) and reinfarction (11.2 vs. 8.1%, P>0.1) as compared with balloon angioplasty.
As compared with balloon angioplasty, routine stenting does reduce angiographic restenosis, without significant benefits in terms of death and reinfarction among patients undergoing primary angioplasty for ST-segment elevation myocardial infarction due to proximal left anterior descending artery occlusion.
在特定的ST段抬高型心肌梗死患者中，直接血管成形术已被证明可改善预后。然而，尚无关于左前降支近端闭塞患者的数据报道。在兹沃勒-6随机试验中，共有1683例连续的ST段抬高型心肌梗死患者被随机分配至支架置入组或球囊血管成形术组，无任何排除标准。本亚组研究的目的是探讨在左前降支近端闭塞患者中，冠状动脉支架置入术与球囊血管成形术相比的益处。
1997年4月至2001年10月，在最初血管造影前被随机分配至支架置入组或球囊血管成形术组的1683例连续的ST段抬高型心肌梗死患者中，共有218例患者接受了左前降支近端闭塞的直接血管成形术。所有患者均有1年的随访数据。
共有107例患者被随机分配至支架置入组，111例患者被分配至球囊血管成形术组。从球囊转换为支架和从支架转换为球囊的交叉率分别为35.1%和13.1%（P<0.0001）。两组在术后心肌梗死溶栓血流、心肌灌注分级、远端栓塞和ST段回落方面具有可比性。在再狭窄（27.6%对53.8%，P=0.03）和靶血管血运重建（15.0%对24.3%，P=0.081）方面，支架置入术具有益处，而与球囊血管成形术相比，在死亡率（11.2%对13.5%，P>0.1）和再梗死率（11.2%对8.1%，P>0.1）方面未观察到差异。
与球囊血管成形术相比，对于因左前降支近端闭塞导致的ST段抬高型心肌梗死患者，在接受直接血管成形术时，常规支架置入术确实可降低血管造影显示的再狭窄率，但在死亡和再梗死方面无显著益处。
