Guthrie Clinic, Sayre, Pennsylvania, USA.
J Interv Cardiol. 2012 Feb;25(1):28-36. doi: 10.1111/j.1540-8183.2011.00677.x. Epub 2011 Oct 9.
The long-term safety and effectiveness of drug-eluting stents (DES) versus bare metal stents (BMS) in non-ST-segment elevation myocardial infarction (NSTEMI) beyond 2 years after percutaneous coronary intervention (PCI) is unknown.
We studied 674 NSTEMI patients who underwent successful PCI with DES (n = 323) or BMS (n = 351). The primary study end-points were time to occurrence of death or nonfatal recurrent myocardial infarction (MI), and stent thrombosis (ST). Secondary end-points included time to occurrence of target vessel revascularization (TVR) and any major adverse cardiovascular event (MACE, defined as the composite of death, MI, ST, TVR).
The DES and BMS groups were well matched except that DES patients received dual antiplatelet therapy for a longer duration and had smaller final vessel diameter. In survival analysis, at a mean follow-up of 1333 ± 659 days after PCI, the DES group had similar incidence of death/myocardial infarction (24% vs. 27%, log rank p = 0.23) and ST (4.0% vs. 2.6%, p = 0.18) as the BMS group. The DES patients had lower incidence of TVR (8.1% vs. 17%, p = 0.0018) but similar MACE (26% vs. 37%, p = 0.31). In multivariable analysis, DES vs. BMS implantation showed no significant impact on death/myocardial infarction [adjusted hazards ratio (HR) 1.0, 95% confidence intervals (CI) 0.7-1.4], ST (HR 1.7; CI 0.7 - 4.0), or MACE (HR 0.8; CI 0.6 - 1.1). However, TVR was lower in the DES group (HR 0.4; CI 0.3 - 0.7).
In patients presenting with NSTEMI, DES implantation appears to be as safe as BMS implantation at long-term follow-up. In addition, DES are effective in reducing TVR compared to BMS.
经皮冠状动脉介入治疗（PCI）后 2 年以上非 ST 段抬高型心肌梗死（NSTEMI）患者中，药物洗脱支架（DES）与金属裸支架（BMS）的长期安全性和有效性尚不清楚。
我们研究了 674 例成功接受 DES（n=323）或 BMS（n=351）PCI 的 NSTEMI 患者。主要研究终点为死亡或非致死性复发性心肌梗死（MI）和支架血栓形成（ST）的发生时间。次要终点包括靶血管血运重建（TVR）和任何主要不良心血管事件（MACE，定义为死亡、MI、ST、TVR 的复合终点）的发生时间。
DES 组和 BMS 组除 DES 组患者接受双联抗血小板治疗时间更长、最终血管直径更小外，两组患者基线特征均衡可比。在生存分析中，DES 组在 PCI 后平均随访 1333±659 天，DES 组的死亡率/心肌梗死发生率（24%比 27%，log rank p=0.23）和 ST 发生率（4.0%比 2.6%，p=0.18）与 BMS 组相似。DES 组 TVR 发生率较低（8.1%比 17%，p=0.0018），但 MACE 发生率相似（26%比 37%，p=0.31）。多变量分析显示，DES 与 BMS 植入相比，对死亡/心肌梗死（调整后的危险比[HR]为 1.0，95%置信区间[CI]为 0.7-1.4）、ST（HR 为 1.7；CI 为 0.7-4.0）或 MACE（HR 为 0.8；CI 为 0.6-1.1）没有显著影响。然而，DES 组 TVR 发生率较低（HR 为 0.4；CI 为 0.3-0.7）。
在 NSTEMI 患者中，DES 植入与长期随访时的 BMS 植入一样安全。此外，DES 可有效降低 TVR 发生率，优于 BMS。
