Department of Internal Medicine, Chonnam National University Medical School, Korea.
Circ J. 2011;75(12):2798-804. doi: 10.1253/circj.cj-11-0586. Epub 2011 Oct 19.
Patients with chronic kidney disease have had conflicting results between drug-eluting stents (DES) and bare-metal stents (BMS). The aim of the present study was to determine whether DES is preferable for the treatment of acute myocardial infarction (AMI) with renal insufficiency, and to elucidate the impact of diabetes mellitus (DM) on outcomes of each stent.
As a part of the Korea Acute Myocardial Infarction Registry (KAMIR), 2,175 AMI patients with renal insufficiency (glomerular filtration rate <60ml/min) comprising 208 patients with BMS and 1,967 DES implantation were selected. Primary outcome was major adverse cardiac event (MACE), defined as a composite of mortality, nonfatal myocardial infarction, and target lesion revascularization. In the overall population, the MACE rate at 1 year was significantly higher in the BMS group than that of DES (44% vs. 26%, P<0.05), which was mainly due to death rather than repeat intervention (44% vs. 26%, P<0.05). In the diabetic group with DES implantation, the MACE rate was higher compared with the DES group without DM, mainly due to repeat intervention (5% vs. 8%, P<0.05).
In AMI patients with renal insufficiency, DES implantation exhibits a favorable 1-year clinical outcome than BMS implantation, and subgroup analysis for diabetic subjects showed worse outcomes in the DM group with implanted DES.
患有慢性肾病的患者在药物洗脱支架（DES）和裸金属支架（BMS）之间的结果存在矛盾。本研究的目的是确定 DES 是否更适合治疗肾功能不全的急性心肌梗死（AMI），并阐明糖尿病（DM）对每种支架治疗结果的影响。
作为韩国急性心肌梗死注册研究（KAMIR）的一部分，选择了 2175 例肾功能不全（肾小球滤过率<60ml/min）的 AMI 患者，包括 208 例 BMS 和 1967 例 DES 植入患者。主要终点是主要不良心脏事件（MACE），定义为死亡、非致死性心肌梗死和靶病变血运重建的复合终点。在总体人群中，BMS 组的 1 年 MACE 发生率明显高于 DES 组（44%比 26%，P<0.05），这主要是由于死亡而不是再次介入（44%比 26%，P<0.05）。在接受 DES 植入的糖尿病组中，MACE 发生率高于无 DM 的 DES 组，主要是由于再次介入（5%比 8%，P<0.05）。
在肾功能不全的 AMI 患者中，DES 植入比 BMS 植入具有更好的 1 年临床结果，对糖尿病患者的亚组分析显示，植入 DES 的 DM 组的结果更差。
