Department of Cardiology, Royal Melbourne Hospital, Monash Center for Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Australia.
Int J Cardiol. 2010 Sep 3;143(3):283-8. doi: 10.1016/j.ijcard.2009.03.064. Epub 2009 Apr 2.
Randomised trials using drug-eluting stents (DES) in ST elevation myocardial infarction (STEMI) have shown mixed results, and excluded patients at the highest risk of adverse outcomes. We aimed to determine the real world clinical outcomes of DES and compare these with bare-metal stents (BMS) in an unrestricted observational study of patients presenting with STEMI.
564 consecutive patients undergoing primary PCI for STEMI were prospectively enrolled in the Melbourne Interventional Group registry (August 2004 to May 2006). The choice of using DES was at the operator's discretion, yet restricted to patients considered at highest risk of restenosis [e.g. diabetes, long lesions (>20 mm) and small target vessels (<2.5 mm)]. Clinical, procedural, and 12-month outcomes of patients receiving DES were evaluated and compared to BMS.
DES were used in 45% of patients presenting with STEMI. The rates of cardiogenic shock were similar in the DES and BMS groups (10.2 vs. 11%, p=0.71). In-hospital outcomes were not significantly different with respect to death (4.7 vs. 7.2%, p=0.23), major adverse cardiac events (MACE) (10.6 vs. 11.3%, p=0.80) or stent thrombosis (1.7 vs. 0.3%, p=0.71). At 12 months, target vessel revascularisation (TVR) in patients with DES was 10.2% vs. 7.2% in BMS (p=0.22). On propensity score adjusted multivariate analyses, the only independent predictor of 12-month MACE was presentation with cardiogenic shock (OR 2.59, 95% C.I 1.04-6.45), and the only predictor of 12-month TVR was reference vessel diameter ≤2.5 mm (OR 2.16, 95% C.I 1.06-4.33). DES use was not independently predictive of lower TVR, MACE rates or mortality. Late stent thrombosis rates were similar (DES 3.2 vs. BMS 3.8%, p=0.65).
Drug-eluting stents are frequently used in Australia in the high-risk setting of STEMI. While target vessel revascularisation rates were moderate in this high-risk group, there was no increased mortality, reinfarction or stent thrombosis compared to bare-metal stents.
在 ST 段抬高型心肌梗死（STEMI）中使用药物洗脱支架（DES）的随机试验结果喜忧参半，且排除了预后不良风险最高的患者。我们旨在确定 DES 的真实世界临床结局，并在一项对 STEMI 患者进行的无限制观察性研究中，将这些结果与裸金属支架（BMS）进行比较。
564 例接受 STEMI 直接经皮冠状动脉介入治疗（PCI）的连续患者前瞻性纳入墨尔本介入组注册研究（2004 年 8 月至 2006 年 5 月）。DES 的使用由术者决定，但仅限于被认为有再狭窄高风险的患者[例如糖尿病、长病变（>20mm）和小靶血管（<2.5mm）]。评估并比较了接受 DES 和 BMS 的患者的临床、手术和 12 个月结局。
STEMI 患者中有 45%使用了 DES。DES 组和 BMS 组的心源性休克发生率相似（10.2%比 11%，p=0.71）。住院期间的死亡率（4.7%比 7.2%，p=0.23）、主要不良心脏事件（MACE）（10.6%比 11.3%，p=0.80）或支架血栓形成（1.7%比 0.3%，p=0.71）无显著差异。12 个月时，DES 组的靶血管血运重建（TVR）率为 10.2%，BMS 组为 7.2%（p=0.22）。在倾向评分调整的多变量分析中，12 个月时 MACE 的唯一独立预测因素是心源性休克（OR 2.59，95%CI 1.04-6.45），12 个月时 TVR 的唯一预测因素是参照血管直径≤2.5mm（OR 2.16，95%CI 1.06-4.33）。DES 的使用与较低的 TVR、MACE 发生率或死亡率无关。晚期支架血栓形成率相似（DES 3.2%比 BMS 3.8%，p=0.65）。
在澳大利亚，DES 常用于 STEMI 的高危环境。在这一高危人群中，靶血管血运重建率适中，但与 BMS 相比，死亡率、再梗死或支架血栓形成无增加。
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