Dziewierz Artur, Siudak Zbigniew, Rakowski Tomasz, Kleczyński Paweł, Zasada Wojciech, Dubiel Jacek S, Dudek Dariusz
2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Catheter Cardiovasc Interv. 2014 Nov 15;84(6):925-31. doi: 10.1002/ccd.25266. Epub 2014 Jul 29.
We sought to evaluate the impact of direct stenting technique on angiographic and clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary angioplasty (PCI).
Data on 1,419 patients who underwent immediate PCI for STEMI with implantation of ≥1 stent within native coronary artery were retrieved from the EUROTRANSFER Registry database. Patients were stratified based on the stent implantation technique: direct (without predilatation) vs. conventional stenting. Propensity score adjustment was used to control possible selection bias.
Direct stenting technique was used in 276 (19.5%) patients. Remaining 1,143 patients were treated with stent implantation after balloon predilatation. Direct compared with conventional stenting resulted in significantly greater rates of postprocedural TIMI grade 3 flow (conventional vs. direct stenting: 91.5% vs. 94.9%, adjusted OR 2.09 (1.13-3.89), P = 0.020), and lower risk of no-reflow (3.4% vs. 1.4%, adjusted OR 0.31 (0.10-0.92), P = 0.035). The rates for ST-segment resolution >50% after PCI were higher in patients treated with direct stenting technique (76.3% vs. 86.2%, adjusted OR 1.64 (1.10-2.46), P = 0.016). A significant reduction in 1-year mortality in patients from the direct stenting group compared with the conventional stenting group, even after adjustment for propensity score was observed (6.5% vs. 2.9%, adjusted OR 0.45 (0.21-0.99), P = 0.047).
When anatomically and technically feasible, the use of direct stenting technique may result in improved long-term survival in patients with STEMI undergoing primary PCI.
我们旨在评估直接支架置入技术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）患者血管造影和临床结局的影响。
从EUROTRANSFER注册数据库中检索1419例因STEMI接受即刻PCI且在自身冠状动脉内植入≥1枚支架的患者的数据。根据支架置入技术对患者进行分层：直接（无预扩张）与传统支架置入。采用倾向评分调整来控制可能的选择偏倚。
276例（19.5%）患者采用直接支架置入技术。其余1143例患者在球囊预扩张后进行支架置入。与传统支架置入相比，直接支架置入术后TIMI 3级血流发生率显著更高（传统支架置入与直接支架置入：91.5%对94.9%，调整后OR 2.09（1.13 - 3.89），P = 0.020），且无复流风险更低（3.4%对1.4%，调整后OR 0.31（0.10 - 0.92），P = 0.035）。直接支架置入技术治疗的患者PCI术后ST段回落>50%的发生率更高（76.3%对86.2%，调整后OR 1.64（1.10 - 2.46），P = 0.016）。即使在调整倾向评分后，直接支架置入组患者的1年死亡率也显著低于传统支架置入组（6.5%对2.9%，调整后OR 0.45（0.21 - 0.99），P = 0.047）。
在解剖和技术可行的情况下，使用直接支架置入技术可能会改善接受直接PCI的STEMI患者的长期生存率。
