Guthrie Clinic, Sayre, Pennsylvania 18840, USA.
J Interv Cardiol. 2012 Apr;25(2):118-25. doi: 10.1111/j.1540-8183.2011.00703.x. Epub 2012 Feb 10.
Multiple randomized trials and observational studies have shown drug-eluting stents (DES) to be safe and effective at 3-year follow-up in stent thrombosis (ST)-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). However, outcomes data beyond 3-4 years after DES implantation are sparse.
We studied 554 STEMI patients who underwent successful PCI with either DES or bare metal stent (BMS). Primary study end-points were time to occurrence of ST and the composite of death or myocardial infarction (MI). Secondary end-points were time to occurrence of major adverse cardiac events (MACEs) and discrete events that comprise MACE (death, MI, and target vessel revascularization [TVR]). Outcomes of the DES and BMS groups were assessed by survival analysis and multivariable Cox regression.
There were 205 (37%) patients who received DES and 349 (63%) patients who received BMS. At a median follow-up of 41.4 months after PCI, there were no differences in the unadjusted incidence of ST (ST, 3.4 vs. 4.3%, log-rank P = 0.61) and MI (6.8% vs. 8%, P = 0.61) between DES versus BMS groups, respectively. However, DES implantation was associated with lower unadjusted incidence of death or MI (11% vs. 23.5%, P = 0.0002), MACE (16% vs. 34%, P < 0.0001), death (6.3% vs. 17%, P = 0.0004), and TVR (9.8% vs. 18%, P = 0.008) than BMS implantation. In multivariable analyses, DES implantation was associated with significantly lower incidence of MACE (adjusted HR = 0.47 [95% CI: 0.31-0.76], P = 0.0007) than BMS implantation.
In our study of STEMI patients, DES implantation was safer than BMS implantation and was associated with lower MACE at long-term follow-up.
多项随机试验和观察性研究表明，在经皮冠状动脉介入治疗（PCI）治疗的 ST 段抬高型心肌梗死（STEMI）患者中，药物洗脱支架（DES）在 3 年随访时安全且有效。然而，DES 植入后 3-4 年以上的结果数据很少。
我们研究了 554 例接受成功 PCI 的 STEMI 患者，这些患者分别接受了 DES 或裸金属支架（BMS）治疗。主要研究终点是发生 ST 和死亡或心肌梗死（MI）的复合终点的时间。次要终点是发生主要不良心脏事件（MACE）和构成 MACE 的离散事件（死亡、MI 和靶血管血运重建[TVR]）的时间。DES 和 BMS 组的结果通过生存分析和多变量 Cox 回归进行评估。
205 例（37%）患者接受 DES 治疗，349 例（63%）患者接受 BMS 治疗。在 PCI 后中位随访 41.4 个月时，DES 组与 BMS 组未调整的 ST 发生率（ST，3.4%比 4.3%，对数秩 P = 0.61）和 MI 发生率（6.8%比 8%，P = 0.61）无差异。然而，DES 植入与未调整的死亡率或 MI 发生率较低（11%比 23.5%，P = 0.0002）、MACE 发生率较低（16%比 34%，P < 0.0001）、死亡率较低（6.3%比 17%，P = 0.0004）和 TVR 发生率较低（9.8%比 18%，P = 0.008）相关。多变量分析显示，与 BMS 植入相比，DES 植入与较低的 MACE 发生率显著相关（调整后的 HR = 0.47[95%CI：0.31-0.76]，P = 0.0007）。
在我们对 STEMI 患者的研究中，DES 植入比 BMS 植入更安全，并且在长期随访中与较低的 MACE 发生率相关。
