University at Albany State University of New York, Albany, New York, USA.
Am J Cardiol. 2011 May 1;107(9):1311-8. doi: 10.1016/j.amjcard.2010.12.043.
The outcomes for patients undergoing percutaneous coronary interventions (PCI) with drug-eluting stents (DESs) and bare metal stents (BMSs) have been compared in many studies for patients with ST-segment elevation myocardial infarction. However, little is known about the relative outcomes for patients with non-ST-segment elevation myocardial infarction (NSTEMI). The aim of the present study was to compare the NSTEMI outcomes for PCI with DESs and BMSs. New York's PCI registry was used to propensity-match 4,776 pairs of patients with NSTEMI who had received DESs and BMSs from January 1, 2003 to December 31, 2007. These patients were followed up through December 31, 2008 to test for differences in mortality, target vessel revascularization, and total repeat revascularization. The outcomes were also compared for various patient subsets. At a median follow-up period of 3.68 years, the patients receiving DESs had significantly lower mortality (16.58% vs 14.52%, difference 2.06%, p<0.001), target vessel revascularization (13.08% vs 11.04%, p=0.009), and total repeat revascularization (22.16% vs 18.77%, p<0.001). The patients receiving paclitaxel-eluting and sirolimus-eluting stents both experienced superior outcomes compared to patients receiving BMSs. The patients receiving DESs had significantly lower mortality rates than their propensity-matched counterparts receiving BMSs when they were ≥65 years (difference 2.29%, p=0.01) and male (difference 2.77%, p=0.003). In conclusion, patients with NSTEMI undergoing PCI experienced lower 4-year mortality, target vessel revascularization, and repeat revascularization rates when they had received DESs than when they had received BMSs, and patients who were >65 years old, and men received notable benefits.
许多研究比较了经皮冠状动脉介入治疗（PCI）中药物洗脱支架（DES）和裸金属支架（BMS）治疗 ST 段抬高型心肌梗死（STEMI）患者的结局。然而，对于非 ST 段抬高型心肌梗死（NSTEMI）患者，DES 和 BMS 的相对结局知之甚少。本研究旨在比较 NSTEMI 患者 PCI 中 DES 和 BMS 的结局。利用纽约 PCI 注册数据库，对 2003 年 1 月 1 日至 2007 年 12 月 31 日期间接受 DES 和 BMS 的 4776 对 NSTEMI 患者进行倾向评分匹配。这些患者随访至 2008 年 12 月 31 日，以检测死亡率、靶血管血运重建和总再次血运重建的差异。还比较了不同患者亚组的结局。在中位随访 3.68 年期间，接受 DES 的患者死亡率显著降低（16.58% vs. 14.52%，差异为 2.06%，p<0.001）、靶血管血运重建（13.08% vs. 11.04%，p=0.009）和总再次血运重建（22.16% vs. 18.77%，p<0.001）。与接受 BMS 的患者相比，接受紫杉醇洗脱支架和西罗莫司洗脱支架的患者的结局均更优。在年龄≥65 岁（差异 2.29%，p=0.01）和男性（差异 2.77%，p=0.003）患者中，接受 DES 的患者死亡率显著低于接受 BMS 的匹配患者。结论：与接受 BMS 的患者相比，NSTEMI 患者 PCI 后 4 年死亡率、靶血管血运重建和再次血运重建率更低，年龄>65 岁和男性患者获益更显著。
