Brar Somjot S, Leon Martin B, Stone Gregg W, Mehran Roxana, Moses Jeffrey W, Brar Simerjeet K, Dangas George
Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York 10032, USA.
J Am Coll Cardiol. 2009 May 5;53(18):1677-89. doi: 10.1016/j.jacc.2009.03.013.
The primary aim of the analysis was to compare outcomes by stent type for death, myocardial infarction (MI), target vessel revascularization (TVR), and stent thrombosis in randomized trials of ST-segment elevation myocardial infarction (STEMI). A secondary analysis was performed among registry studies.
It is not known whether there are differences in outcomes between drug-eluting stents (DES) and bare-metal stents (BMS) for STEMI.
We searched MEDLINE, EMBASE, the Cochrane Library, and Internet sources for articles comparing outcomes between DES and BMS among patients with STEMI between January 2000 and October 2008. Randomized controlled trials and registries including patients 18 years of age and older receiving a DES or BMS were included. We extracted variables related to the study design, setting, participants, and clinical end points.
Thirteen randomized trials were identified (N = 7,352). Compared with BMS, DES significantly reduced TVR (relative risk [RR]: 0.44; 95% confidence interval [CI]: 0.35 to 0.55), without increasing death (RR: 0.89; 95% CI: 0.70 to 1.14), MI (RR: 0.82; 95% CI: 0.64 to 1.05), or stent thrombosis (RR: 0.97; 95% CI: 0.73 to 1.28). These observations were durable over 2 years. Among 18 registries (N = 26,521), DES significantly reduced TVR (RR: 0.54; 95% CI: 0.40 to 0.74) without an increase in MI (RR: 0.87, 95% CI: 0.62 to 1.23). Death was significantly lower in the DES group within 1 year of the index percutaneous coronary intervention, but there were no differences within 2 years (p = 0.45).
The use of DES appears safe and efficacious in randomized trials and registries of patients with STEMI. The DES significantly reduce TVR compared with BMS, without an increase in death, MI, or stent thrombosis within 2 years of the index procedure.
本分析的主要目的是在ST段抬高型心肌梗死（STEMI）的随机试验中，比较不同类型支架在死亡、心肌梗死（MI）、靶血管重建术（TVR）和支架血栓形成方面的结局。在注册研究中进行了二次分析。
对于STEMI患者，药物洗脱支架（DES）和裸金属支架（BMS）在结局上是否存在差异尚不清楚。
我们检索了MEDLINE、EMBASE、Cochrane图书馆和互联网资源，以查找2000年1月至2008年10月期间比较STEMI患者中DES和BMS结局的文章。纳入18岁及以上接受DES或BMS的患者的随机对照试验和注册研究。我们提取了与研究设计、环境、参与者和临床终点相关的变量。
确定了13项随机试验（N = 7352）。与BMS相比，DES显著降低了TVR（相对风险[RR]：0.44；95%置信区间[CI]：0.35至0.55），且未增加死亡（RR：0.89；95%CI：0.70至1.14）、MI（RR：0.82；95%CI：0.64至1.05）或支架血栓形成（RR：0.97；95%CI：0.73至1.28）。这些观察结果在2年内持续存在。在18项注册研究（N = 26521）中，DES显著降低了TVR（RR：0.54；95%CI：0.40至0.74），且未增加MI（RR：0.87，95%CI：0.62至1.23）。在首次经皮冠状动脉介入治疗后1年内，DES组的死亡显著较低，但2年内无差异（p = 0.45）。
在STEMI患者的随机试验和注册研究中，使用DES似乎是安全有效的。与BMS相比，DES在首次手术2年内显著降低了TVR，且未增加死亡、MI或支架血栓形成。
