Tacoy Gulten, Yazici Guliz Erdem, Erden Murat, Timurkaynak Timur
Gazi University, Faculty of Medicine, Cardiology Department, Ankara, Turkey.
Ther Adv Cardiovasc Dis. 2009 Jun;3(3):181-6. doi: 10.1177/1753944709335755. Epub 2009 May 22.
The aim of this study was to compare direct and conventional stenting procedure in the subacute stable phase on short- and long-term results in patients with ST elevation myocardial infarction.
Eighty-eight clinically stable ST-segment elevation myocardial infarction (STEMI) patients were enrolled into the study. The patients were classified as group I (direct stenting) and group II (conventional stenting - stenting after balloon dilatation). Baseline characteristics of patients were scanned from hospital records. Coronary angiograms before and after the revascularization procedure were evaluated with the quantitative coronary angiogram technique. Patients were followed for 5 years for clinical outcomes. The study population consisted of 58 patients (65%) in group I and 30 patients (35%) in group II. Mean ages were 55.8 +/- 10.8 and 57.3 +/- 9.8, respectively.
There were no significant differences between the two groups regarding clinical characteristics (hypertension, diabetes mellitus, family history of cardiovascular disease, smoking and dyslipidemia). The thrombus score was similar in both groups. Diameter stenosis was lower in group I (54.8 +/- 12.7 versus 61.4 +/- 12.6; p = 0.023) and TFC (Thrombolysis in Myocardial Infarction frame count) was higher in group II (30.7 +/- 14.5 versus 40.8 +/- 26.7; p = 0.02) before the percutaneous coronary intervention (PCI). Other quantitative angiographic parameters were not different. For all angiographic criteria, the difference between pre- and post-PCI parameters was significantly different in both groups. However, the change in TFC was higher within the group II compared to pre-PCI TFC rates. This difference was statistically significant (p = 0.002). Procedural success was statistically different between groups (69% in group I, 43% in group II; p50.01). Immediate clinical and angiographic results were similar. At 5-year follow-up the incidence of major adverse cardiac events including death, angina pectoris and myocardial infarction were similar for direct stenting versus conventional angioplasty.
Direct stenting is safe and feasible for the treatment in patients with STEMI at the subacute phase. Immediate clinic, angiographic and late clinical results are similar for direct stenting and conventional stenting following balloon angioplasty. Although conventional stenting improved TFC better than direct stenting, this did not translate to better clinical outcomes.
本研究旨在比较亚急性稳定期直接支架置入术与传统支架置入术对ST段抬高型心肌梗死患者短期和长期结果的影响。
88例临床稳定的ST段抬高型心肌梗死（STEMI）患者纳入本研究。患者分为I组（直接支架置入组）和II组（传统支架置入组——球囊扩张后支架置入组）。从医院记录中扫描患者的基线特征。采用定量冠状动脉造影技术评估血运重建术前和术后的冠状动脉造影。对患者进行5年的临床结果随访。研究人群包括I组的58例患者（65%）和II组的30例患者（35%）。平均年龄分别为55.8±10.8岁和57.3±9.8岁。
两组在临床特征（高血压、糖尿病、心血管疾病家族史、吸烟和血脂异常）方面无显著差异。两组的血栓评分相似。在经皮冠状动脉介入治疗（PCI）前，I组的直径狭窄较低（54.8±12.7对61.4±12.6；p = 0.023），II组的心肌梗死溶栓帧数（TFC）较高（30.7±14.5对40.8±26.7；p = 0.02）。其他定量血管造影参数无差异。对于所有血管造影标准，两组PCI前后参数的差异均有统计学意义。然而，与PCI前的TFC率相比，II组内TFC的变化更高。这种差异具有统计学意义（p = 0.002）。两组之间的手术成功率有统计学差异（I组为69%，II组为43%；p<0.01）。即刻临床和血管造影结果相似。在5年随访中，直接支架置入术与传统血管成形术相比，包括死亡、心绞痛和心肌梗死在内的主要不良心脏事件发生率相似。
直接支架置入术对亚急性期STEMI患者的治疗是安全可行的。直接支架置入术与球囊血管成形术后的传统支架置入术的即刻临床、血管造影和晚期临床结果相似。尽管传统支架置入术在改善TFC方面优于直接支架置入术，但这并未转化为更好的临床结果。
