Division of Cardiology, Department of Internal Medicine, Washington Hospital Center, District of Columbia.
J Interv Cardiol. 2011 Aug;24(4):320-5. doi: 10.1111/j.1540-8183.2011.00643.x. Epub 2011 Apr 27.
Despite significant advances in stent technology and pharmacotherapy, drug-eluting stent thrombosis (DES-ST) remains a major complication of percutaneous coronary intervention (PCI) and commonly presents as ST-elevation myocardial infarction (STEMI). There are currently little data comparing the in-hospital outcomes of patients presenting with STEMI due to DES-ST with those due to de novo coronary artery disease (CAD).
Our study comprised 985 consecutive patients who underwent primary PCI for STEMI, 102 of whom were diagnosed as having a definite DES-ST. The primary end-point was the in-hospital composite of death or recurrent myocardial infarction (MI). The secondary end-point was the in-hospital maximum rise in creatine kinase (myocardial band [MB] fraction) and troponin I.
The DES-ST group had a higher proportion of patients with diabetes mellitus, hypercholesterolemia, history of ischemic heart disease, coronary revascularization, and chronic renal impairment. The adjusted primary end-point was higher in the DES-ST cohort (12.7% vs. 7.4%; P = 0.05). The 2 cohorts did not differ in the secondary end-point. The independent predictors of the primary end-point were age (hazard ratio [HR]= 1.04; 95% confidence interval [CI]= 1.01 - 1.06; P = 0.005), cardiogenic shock (HR = 11.5; 95% CI = 6.38 - 20.07, P < 0.001), and lesions involving the left anterior descending coronary artery (HR = 1.8; 95% CI = 1.03 - 3.13, P = 0.04). DES-ST was not an independent predictor of the primary end-point (HR = 1.18; 95% CI = 0.53-2.63, P = 0.38).
Patients with STEMI secondary to DES-ST have a poorer in-hospital outcome than do patients in whom STEMI is due to de novo CAD. This difference may be predominantly driven by differences in the baseline characteristics between these cohorts. (J Interven Cardiol 2011;24:320-325).
尽管支架技术和药物治疗取得了重大进展，但药物洗脱支架血栓形成（DES-ST）仍然是经皮冠状动脉介入治疗（PCI）的主要并发症，通常表现为 ST 段抬高型心肌梗死（STEMI）。目前，关于因药物洗脱支架血栓形成导致的 STEMI 患者与因新发冠状动脉疾病（CAD）导致的 STEMI 患者的住院期间结局比较，数据较少。
我们的研究纳入了 985 例因 STEMI 接受直接 PCI 的连续患者，其中 102 例被诊断为明确的药物洗脱支架血栓形成。主要终点是死亡或复发性心肌梗死（MI）的住院期间复合终点。次要终点是肌酸激酶（心肌带[MB]分数）和肌钙蛋白 I 的住院期间最大升高。
DES-ST 组有更高比例的糖尿病、高胆固醇血症、缺血性心脏病史、冠状动脉血运重建和慢性肾功能不全患者。调整后的主要终点在 DES-ST 组更高（12.7%比 7.4%；P=0.05）。两组在次要终点上没有差异。主要终点的独立预测因素是年龄（危险比[HR]=1.04；95%置信区间[CI]=1.01-1.06；P=0.005）、心源性休克（HR=11.5；95%CI=6.38-20.07，P<0.001）和累及左前降支冠状动脉的病变（HR=1.8；95%CI=1.03-3.13，P=0.04）。DES-ST 不是主要终点的独立预测因素（HR=1.18；95%CI=0.53-2.63，P=0.38）。
因药物洗脱支架血栓形成导致的 STEMI 患者的住院期间结局比因新发 CAD 导致的 STEMI 患者差。这种差异可能主要是由这两个队列之间的基线特征差异驱动的。（J 介入心脏病学 2011；24：320-325）。
