Department of Cardiology, Odense University Hospital, Sdr. Boulevard 29, Odense, Denmark.
Circ Cardiovasc Interv. 2008 Dec;1(3):176-84. doi: 10.1161/CIRCINTERVENTIONS.108.794578.
The use of drug-eluting stents (DESs) versus bare metal stents (BMSs) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is a matter of debate. Therefore, we examined the risk of target lesion revascularization (TLR), stent thrombosis, myocardial infarction, and death after the implantation of DES or BMS in primary PCI patients in Western Denmark.
A total of 3756 consecutive patients with ST-segment elevation myocardial infarction treated with primary PCI and stent implantation, recorded in the Western Denmark Heart Registry from January 2002 through June 2005, were followed up for 2 years. We used Cox regression analysis to control for confounding. The 2-year incidence of definite stent thrombosis was 1.9% in the DES group and 1.1% in the BMS group (adjusted relative risk [RR]=1.53; 95% CI=0.84 to 2.78; P=0.17). Very late definite stent thrombosis (> or =12 months) was seen in 0.4% in the DES group and 0.06% in the BMS group (adjusted RR=6.74; 95% CI=1.23 to 37.00; P=0.03). The 2-year incidence of myocardial infarction was similar in the 2 groups, 5.2% in the DES group versus 6.3% in the BMS group (P=0.28; adjusted RR=1.13; 95% CI=0.81 to 1.59; P=0.47). All-cause 2-year mortality was 7.8% in the DES group and 11.4% in BMS group (P<0.004; adjusted RR=0.79; 95% CI=0.60 to 1.04; P=0.09). The 2-year incidence of target lesion revascularization was 7.2% in the DES group and 8.7% in the BMS group (P=0.09; adjusted RR=0.70; 95% CI=0.52 to 0.92; P=0.012).
In ST-segment elevation myocardial infarction patients treated with primary PCI, target lesion revascularization was reduced by 30% in patients treated with a DES. The risk of very late definite stent thrombosis was low but increased in patients treated with DES. DES was not associated with increased risk of myocardial infarction or death, when compared with BMS.
在急性 ST 段抬高型心肌梗死患者的经皮冠状动脉介入治疗（PCI）中，药物洗脱支架（DES）与金属裸支架（BMS）的应用存在争议。因此，我们在丹麦西部的一项研究中评估了在急性 ST 段抬高型心肌梗死患者中接受 DES 或 BMS 支架植入后的靶病变血运重建（TLR）、支架血栓形成、心肌梗死和死亡的风险。
我们对 2002 年 1 月至 2005 年 6 月在丹麦西部心脏注册中心登记的连续 3756 例接受直接 PCI 和支架植入术治疗的急性 ST 段抬高型心肌梗死患者进行了随访，随访时间为 2 年。我们使用 Cox 回归分析来控制混杂因素。DES 组和 BMS 组 2 年时明确的支架血栓形成发生率分别为 1.9%和 1.1%（校正后的相对风险[RR]为 1.53；95%置信区间[CI]为 0.84 至 2.78；P=0.17）。DES 组中有 0.4%的患者出现非常晚期的明确支架血栓形成（>12 个月），BMS 组中为 0.06%（校正 RR 为 6.74；95%CI 为 1.23 至 37.00；P=0.03）。两组 2 年时心肌梗死的发生率相似，DES 组为 5.2%，BMS 组为 6.3%（P=0.28；校正 RR 为 1.13；95%CI 为 0.81 至 1.59；P=0.47）。DES 组和 BMS 组的全因 2 年死亡率分别为 7.8%和 11.4%（P<0.004；校正 RR 为 0.79；95%CI 为 0.60 至 1.04；P=0.09）。DES 组和 BMS 组的 2 年时 TLR 发生率分别为 7.2%和 8.7%（P=0.09；校正 RR 为 0.70；95%CI 为 0.52 至 0.92；P=0.012）。
在接受直接 PCI 治疗的急性 ST 段抬高型心肌梗死患者中，DES 治疗组的 TLR 减少了 30%。DES 治疗组的非常晚期明确支架血栓形成风险较低，但增加。与 BMS 相比，DES 并不增加心肌梗死或死亡的风险。
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