The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea. ; Apollo Gleneagles Hospital, Kolkata, India.
Korean Circ J. 2012 Dec;42(12):830-8. doi: 10.4070/kcj.2012.42.12.830. Epub 2012 Dec 31.
Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). We sought to compare different coronary stents used during primary PCI in patients with ST-elevation myocardial infarction (STEMI) and CKD.
We selected 2408 consecutive STEMI patients with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m(2)) undergoing primary PCI and divided them into 5 groups based on the type of stent implanted: 1) bare metal stent (BMS), 2) paclitaxel-eluting stent (PES), 3) sirolimus-eluting stent (SES), 4) zotarolimus-eluting stent (ZES), or 5) everolimus-eluting stent (EES). The study endpoint was the number of major adverse cardiac events (MACE) at 12 months.
There was no significant difference in the incidence of 12-month myocardial infarction, target lesion revascularization, or target vessel revascularization between stent groups; however, the overall rate of repeat revascularization differed significantly between groups. All-cause death differed significantly among the groups. The incidence of 12-month MACE in BMS, PES, SES, ZES, and EES was 8.3%, 9.8%, 8.6%, 5.5%, and 2.6%, respectively (p<0.001). Kaplan-Meier analysis did not show a significant differences in 12-month MACE-free survival among the groups (log-rank p=0.076). This finding remained the same after adjusting for multiple confounders (p=0.147).
Any of the 5 stents can be used to treat STEMI patients with CKD undergoing primary PCI; all have similar risk of 12-month MACE. This result is hypothesis-generating and warrants further evaluation with a long-term randomized study.
慢性肾脏病（CKD）与经皮冠状动脉介入治疗（PCI）后的不良预后相关。我们旨在比较 ST 段抬高型心肌梗死（STEMI）合并 CKD 患者行直接 PCI 时使用的不同冠状动脉支架。
我们选择了 2408 例连续的 CKD（肾小球滤过率<60mL/min/1.73m2）STEMI 患者，根据植入的支架类型将他们分为 5 组：1）裸金属支架（BMS），2）紫杉醇洗脱支架（PES），3）西罗莫司洗脱支架（SES），4）佐他莫司洗脱支架（ZES）或 5）依维莫司洗脱支架（EES）。研究终点为 12 个月时的主要不良心脏事件（MACE）数量。
支架组间 12 个月时心肌梗死、靶病变血运重建或靶血管血运重建的发生率无显著差异；然而，重复血运重建的总体发生率在各组间有显著差异。各组间全因死亡率也有显著差异。BMS、PES、SES、ZES 和 EES 组 12 个月时的 MACE 发生率分别为 8.3%、9.8%、8.6%、5.5%和 2.6%（p<0.001）。Kaplan-Meier 分析显示各组间 12 个月 MACE 无事件生存率无显著差异（对数秩检验 p=0.076）。调整多个混杂因素后，这一发现仍然不变（p=0.147）。
对于直接 PCI 治疗的 STEMI 合并 CKD 患者，5 种支架中的任何一种都可用于治疗，12 个月时的 MACE 风险相似。这一结果只是一个假设，需要进一步通过长期随机研究进行评估。
