Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
EuroIntervention. 2012 Jan;7(9):1021-9. doi: 10.4244/EIJV7I9A164.
To evaluate the clinical outcomes of sirolimus-eluting stent (SES) versus bare metal stent (BMS) implantation in patients with ST-segment elevation myocardial infarction (STEMI) at long-term follow-up.
After five years, 310 STEMI patients randomly assigned to implantation of either SES or BMS, were compared. Survival rates were comparable between groups (SES 94.3% vs. BMS 92.8%, p=0.57), as were the rates of reinfarction (10.6% vs. 13.7%, p=0.40), freedom of death/re-MI (84.4% vs. 79.8%, p=0.29) and target vessel failure (14.9% vs. 21.7%, p=0.11). Likewise, rates of overall stent thrombosis (ST) (5.4% vs. 2.7%, p=0.28) and very late ST (4.1% vs. 0.7%, p=0.07) did not significantly differ between the SES- and BMS-group. In 184 patients with IVUS data, definite and definite/probable VLST was more common in those with late stent malapposition versus those without late stent malapposition (4.3% and 6.6% vs. no events [p=0.018 and p=0.004], respectively). The cumulative incidences of target vessel and target lesion revascularisation (TVR and TLR) were not significantly lower in the SES-group (11.2% vs. 17.9%, p=0.09 and 7.2% vs. 12.9%, p=0.08), as was the rate of clinically driven TLR (6.6% vs. 9.5%, p=0.30).
SES implantation was neither associated with increased rates of major adverse cardiac events, nor with a reduction in re-intervention, compared to implantation of a BMS in patients with STEMI after five years. However, a trend of more very late stent thrombosis was observed after SES implantation (ISRCTN62825862).
评估在长期随访中，雷帕霉素洗脱支架（SES）与金属裸支架（BMS）植入治疗 ST 段抬高型心肌梗死（STEMI）患者的临床结果。
五年后，比较了 310 名随机分配至 SES 或 BMS 植入的 STEMI 患者。两组的生存率无差异（SES 94.3% vs. BMS 92.8%，p=0.57），再梗死率（10.6% vs. 13.7%，p=0.40）、无死亡/再心梗率（84.4% vs. 79.8%，p=0.29）和靶血管失败率（14.9% vs. 21.7%，p=0.11）也无差异。同样，SES 组和 BMS 组的总体支架血栓形成率（ST）（5.4% vs. 2.7%，p=0.28）和极晚期 ST（4.1% vs. 0.7%，p=0.07）也无显著差异。在 184 名接受 IVUS 数据的患者中，与无晚期支架贴壁不良的患者相比，晚期支架贴壁不良的患者更常见明确和明确/可能极晚期 ST（4.3%和 6.6% vs. 无事件[ p=0.018 和 p=0.004]）。SES 组的靶血管和靶病变血运重建（TVR 和 TLR）累积发生率也没有显著降低（11.2% vs. 17.9%，p=0.09 和 7.2% vs. 12.9%，p=0.08），临床驱动的 TLR 发生率也没有降低（6.6% vs. 9.5%，p=0.30）。
与 5 年后接受 BMS 植入的 STEMI 患者相比，SES 植入术既不会增加主要不良心脏事件的发生率，也不会减少再次介入治疗的发生率。然而，SES 植入术后观察到极晚期支架血栓形成的趋势增加（ISRCTN62825862）。
