Hannan Edward L, Racz Michael, Walford Gary, Holmes David R, Jones Robert H, Sharma Samin, Katz Stanley, King Spencer B
School of Public Health, Department of Health Policy, Management, and Behavior, University at Albany, State University of New York, Albany, New York 12144-3456, USA.
JACC Cardiovasc Interv. 2008 Apr;1(2):129-35. doi: 10.1016/j.jcin.2008.01.006.
The purpose of this study was to compare outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) for patients with ST-segment elevation myocardial infarction (STEMI).
Despite some controversy related to late stent thromboses, DES are approved for use in many patients undergoing stenting. However, there are several types of patients in whom implanting a DES would be regarded as off-label use, and this study compares DES and BMS for one of these groups.
New York's percutaneous coronary intervention registry was used to identify 772 patients undergoing percutaneous coronary intervention (PCI) for STEMI who received BMS and 1,154 STEMI patients who received DES between October 1, 2003, and December 31, 2004. These patients were tracked through December 31, 2005. Mortality, target vessel PCI, and subsequent coronary artery bypass graft (CABG) surgery within 2 years of undergoing the procedure were captured. Adverse outcomes were adjusted using proportional hazards methods to account for baseline differences in patients' severity of illness.
The BMS patients had significantly higher mortality (adjusted hazard ratio [HR] vs. DES = 2.01, 95% confidence interval [CI] 1.21 to 3.34, risk-adjusted mortality = 8.6% vs. 5.0%, p = 0.007) and significantly higher subsequent CABG surgery (adjusted HR vs. DES = 2.33, 95% CI 1.31 to 4.16, risk-adjusted rate = 6.4% vs. 3.0%, p = 0.004) rates. There was no difference by type of DES (adjusted HR for paclitaxel-eluting stent versus sirolimus-eluting stent; mortality 0.72, 95% CI 0.30 to 1.72), subsequent CABG surgery (adjusted HR = 0.60, 95% CI 0.26 to 1.40), and target vessel PCI (adjusted HR = 0.74, 95% CI 0.35 to 1.58).
In this observational study, DES were associated with lower mortality and subsequent CABG surgery when used for STEMI patients.
本研究旨在比较药物洗脱支架（DES）和裸金属支架（BMS）用于ST段抬高型心肌梗死（STEMI）患者的治疗效果。
尽管对于晚期支架血栓形成存在一些争议，但DES已被批准用于许多接受支架植入术的患者。然而，有几类患者植入DES被视为标签外使用，本研究比较了DES和BMS在其中一组患者中的应用情况。
利用纽约经皮冠状动脉介入治疗注册数据库，确定了2003年10月1日至2004年12月31日期间接受经皮冠状动脉介入治疗（PCI）的772例STEMI患者，这些患者接受了BMS，以及1154例接受DES的STEMI患者。对这些患者进行随访至2005年12月31日。记录手术2年内的死亡率、靶血管PCI以及后续冠状动脉旁路移植术（CABG）手术情况。采用比例风险方法对不良结局进行校正，以考虑患者疾病严重程度的基线差异。
BMS组患者的死亡率显著更高（校正风险比[HR]与DES相比=2.01，95%置信区间[CI]1.21至3.34，风险校正死亡率=8.6%对5.0%，p=0.007），后续CABG手术率也显著更高（校正HR与DES相比=2.33，95%CI 1.31至4.16，风险校正率=6.4%对3.0%，p=0.004）。不同类型的DES之间在死亡率（紫杉醇洗脱支架与西罗莫司洗脱支架的校正HR；死亡率0.72，95%CI 0.30至1.72）、后续CABG手术（校正HR=0.60，95%CI 0.26至1.40）和靶血管PCI（校正HR=0.74，95%CI 0.35至1.58）方面没有差异。
在这项观察性研究中，DES用于STEMI患者时与较低的死亡率和后续CABG手术相关。
