闭塞动脉试验（OAT）中经皮冠状动脉介入治疗梗死相关动脉药物洗脱支架或裸金属支架与单纯药物治疗的长期结果。

BACKGROUND

The OAT, a randomized study of routine percutaneous coronary intervention or optimal medical therapy (MED) alone for the treatment of a totally occluded infarct-related artery in the subacute phase after myocardial infarction, showed similar rates of death, reinfarction and congestive heart failure (CHF) between study groups. Although most percutaneous coronary intervention patients were treated with bare metal stents (BMS), drug-eluting stents (DES) were also implanted in the latter part of the study. The aim of the study was to conduct an exploratory analysis of long-term outcomes for DES vs. BMS deployment vs. MED in the OAT.

METHODS

Patients enrolled after February 2003 (when first DES was implanted) were followed (DES n = 79, BMS n = 393, MED n = 552) up to a maximum of 6 years (mean survivor follow-up 5.1 years).

RESULTS

The 6-year occurrence of the composite end point of death, reinfarction and class IV CHF was similar [20.4% of DES, 18.9% of BMS and 18.4% of MED (P = .66)] as were the rates of the components of the primary end point. During the follow-up period, 33.4% of DES, 44.4% of BMS and 48.1% of MED patients, developed angina (P = .037). The rate of revascularization during follow up was 11.3%, 20.5% and 22.5% among these groups, respectively (P = .045).

CONCLUSIONS

There is no suggestion of reduced long-term risk of death, reinfarction or class IV CHF with DES usage compared to BMS or medical treatment alone. An association between DES use and freedom from angina and revascularization relative to medical therapy is suggested.

背景

OAT 是一项随机研究，比较了常规经皮冠状动脉介入治疗或单纯最佳药物治疗（MED）治疗急性心肌梗死后亚急性期完全闭塞的梗死相关动脉的效果，结果显示两组之间的死亡率、再梗死率和充血性心力衰竭（CHF）发生率相似。尽管大多数经皮冠状动脉介入治疗患者使用了裸金属支架（BMS），但在研究后期也植入了药物洗脱支架（DES）。本研究旨在对 OAT 中 DES 与 BMS 与 MED 长期结果进行探索性分析。

方法

2003 年 2 月后（首次植入 DES 时）入组的患者进行随访（DES 组 n = 79，BMS 组 n = 393，MED 组 n = 552），随访时间最长达 6 年（平均幸存者随访时间为 5.1 年）。

结果

DES 组、BMS 组和 MED 组的 6 年复合终点（死亡、再梗死和 IV 级 CHF）发生率相似[DES 组 20.4%、BMS 组 18.9%和 MED 组 18.4%（P =.66）]，主要终点的各组成部分发生率也相似。在随访期间，DES 组、BMS 组和 MED 组分别有 33.4%、44.4%和 48.1%的患者发生心绞痛（P =.037）。随访期间的血运重建率分别为 11.3%、20.5%和 22.5%（P =.045）。