急性 ST 段抬高型心肌梗死直接支架置入术后晚期支架贴壁不良的机制：选择试验的亚分析。
Mechanisms of late stent malapposition after primary stenting in ST-elevation myocardial infarction: a subanalysis of the selection trial.
机构信息
Cardiologia e Cardiologia Invasiva 2, A.O.U. Careggi, Florence, Italy.
出版信息
J Interv Cardiol. 2009 Jun;22(3):201-6. doi: 10.1111/j.1540-8183.2009.00461.x. Epub 2009 Apr 2.
BACKGROUND
One of the major predictors of late stent malapposition (LSM) is primary stenting in acute myocardial infarction. However, mechanisms of LSM are still under debate.
METHODS
Patients with ST-elevation myocardial infarction (STEMI) and enrolled in the SELECTION trial (38 patients in the paclitaxel-eluting stent, PES, and 35 in the bare metal stent, BMS, cohort) were retrospectively analyzed to evaluate LSM, by means of intravascular ultrasound (IVUS) data recorded at the index and 7-month follow-up procedures.
RESULTS
Stent malapposition was documented in 21 lesions in 21 patients (28.8%): in 8 of these 21 patients (38.1%) it was LSM. Although statistical significance was not reached, LSM was more frequent after PES than BMS implantation (15.8% vs. 5.7%). LSM was mainly located within the body of the stent (62.5% of the cases). At the LSM segment, a significant increase of vessel area (19.2 +/- 3.3 mm(2) vs. 21.9 +/- 5.3 mm(2), P = 0.04) and a reduction of plaque area (12.6 +/- 4.6 mm(2) vs. 9.1 +/- 3.9 mm(2), P = 0.04) were observed at IVUS between the index and follow-up procedure.
CONCLUSIONS
After primary stenting for STEMI, LSM seems to be more frequent after PES rather than BMS implantation. In the STEMI setting, possible mechanisms leading to LSM include positive remodeling and plaque mass decrease.
背景
晚期支架贴壁不良（LSM）的主要预测因素之一是急性心肌梗死的直接支架置入。然而，LSM 的机制仍存在争议。
方法
回顾性分析接受 ST 段抬高型心肌梗死（STEMI）治疗并入选 SELECTION 试验（紫杉醇洗脱支架组 38 例，裸金属支架组 35 例）的患者，通过在指数和 7 个月随访过程中记录的血管内超声（IVUS）数据来评估 LSM。
结果
在 21 例患者的 21 个病变中发现支架贴壁不良：21 例患者中有 8 例（38.1%）存在 LSM。尽管未达到统计学意义，但 PES 植入后 LSM 比 BMS 植入更为常见（15.8%比 5.7%）。LSM 主要位于支架体部（62.5%的病例）。在 LSM 节段，IVUS 显示血管面积（19.2 +/- 3.3 mm(2)比 21.9 +/- 5.3 mm(2)，P = 0.04）和斑块面积（12.6 +/- 4.6 mm(2)比 9.1 +/- 3.9 mm(2)，P = 0.04）在指数和随访过程中显著增加。
结论
在 STEMI 患者中进行直接支架置入后，PES 植入后 LSM 似乎比 BMS 植入更为常见。在 STEMI 环境中，导致 LSM 的可能机制包括正性重构和斑块质量减少。
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