Isik Turgay, Ayhan Erkan, Uyarel Huseyin, Ergelen Mehmet, Cicek Gokhan, Osmonov Damirbek, Turkkan Ceyhan, Turer Ayca, Ghannadian Bahman, Eren Mehmet
Department of Cardiology, School of Medicine, Balikesir University, Balikesir, Turkey.
Coron Artery Dis. 2012 Aug;23(5):348-53. doi: 10.1097/MCA.0b013e3283548862.
The aim of our study was to determine the impact of direct stenting (DS) on procedural success and the in-hospital outcome among patients with ST-elevation myocardial infarction (STEMI) treated with a primary percutaneous coronary intervention (PCI).
With improvements in stent designs, DS has become more widespread. The theoretical advantages of DS include a shorter procedural time, a lower contrast dose, and reduced spiral dissections, along with reduced radiation exposure and procedural costs.
A total of 1992 consecutive STEMI patients were reviewed; 621 patients (31.2%) were included in the DS group and 1371 (68.8%) in the conventional stenting (CS) group. The clinical and angiographic characteristics, in-hospital outcomes, and predictors of unsuccessful primary angioplasty were analyzed.
The incidence of in-hospital major adverse cardiac events (MACE) was 6.1% in the CS group and 4.3% in the DS group. The difference between the two patient groups was not statistically significant for myocardial reinfarction (re-MI), target-vessel revascularization, and MACE. Nonetheless, the rates of in-hospital mortality and advanced heart failure were significantly lower in the DS group. CS [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.65-7.37, P=0.001], Killip class 2/3 (OR 2.5, 95% CI 1.2-5.23, P=0.01), glomerular filtration rateless than 60 ml/min/1.73 m (OR 2.2, 95% CI 1.22-3.94, P=0.008), and anterior MI (OR 1.61, 95% CI 1.01-2.56, P=0.04) were found to be independent predictors of unsuccessful procedures.
DS improves the in-hospital outcomes of STEMI patients treated with primary PCI, particularly by reducing the rates of in-hospital mortality and advanced heart failure. CS was an independent predictor of unsuccessful PCI.
我们研究的目的是确定直接支架置入术（DS）对接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者手术成功率和院内结局的影响。
随着支架设计的改进，DS已变得更为普遍。DS的理论优势包括手术时间更短、造影剂剂量更低、螺旋状夹层减少，以及辐射暴露和手术成本降低。
回顾了1992例连续的STEMI患者；621例患者（31.2%）纳入DS组，1371例（68.8%）纳入传统支架置入术（CS）组。分析了临床和血管造影特征、院内结局以及初次血管成形术失败的预测因素。
CS组院内主要不良心脏事件（MACE）发生率为6.1%，DS组为4.3%。两组患者在心肌再梗死（再发MI）、靶血管血运重建和MACE方面的差异无统计学意义。尽管如此，DS组的院内死亡率和重度心力衰竭发生率显著更低。CS（比值比[OR]3.49，95%置信区间[CI]1.65 - 7.37，P = 0.001）、Killip分级2/3级（OR 2.5，95%CI 1.2 - 5.23，P = 0.01）、肾小球滤过率低于60 ml/min/1.73 m²（OR 2.2，95%CI 1.22 - 3.94，P = 0.008）以及前壁MI（OR 1.61，95%CI 1.01 - 2.56，P = 0.04）被发现是手术失败的独立预测因素。
DS改善了接受直接PCI的STEMI患者的院内结局，特别是通过降低院内死亡率和重度心力衰竭发生率。CS是PCI失败的独立预测因素。
