Jaguszewski Milosz, Radovanovic Dragana, Nallamothu Brahmajee K, Urban Philip, Erne Paul
Divison of Cardiology, Luzerner Kantonsspital, Lucerne.
Kardiol Pol. 2014;72(4):315-23. doi: 10.5603/KP.a2013.0346. Epub 2013 Dec 2.
Recently, it has been suggested that the type of stent used in primary percutaneous coronary interventions (pPCI) might impact upon the outcomes of patients with acute myocardial infarction (AMI). Indeed, drug-eluting stents (DES) reduce neointimal hyperplasia compared to bare-metal stents (BMS). Moreover, the later generation DES, due to its biocompatible polymer coatings and stent design, allows for greater deliverability, improved endothelial healing and therefore less restenosis and thrombus generation. However, data on the safety and performance of DES in large cohorts of AMI is still limited.
To compare the early outcome of DES vs. BMS in AMI patients.
This was a prospective, multicentre analysis containing patients from 64 hospitals in Switzerland with AMI undergoing pPCI between 2005 and 2013. The primary endpoint was in-hospital all-cause death, whereas the secondary endpoint included a composite measure of major adverse cardiac and cerebrovascular events (MACCE) of death, reinfarction, and cerebrovascular event.
Of 20,464 patients with a primary diagnosis of AMI and enrolled to the AMIS Plus registry, 15,026 were referred for pPCI and 13,442 received stent implantation. 10,094 patients were implanted with DES and 2,260 with BMS. The overall in-hospital mortality was significantly lower in patients with DES compared to those with BMS implantation (2.6% vs. 7.1%,p < 0.001). The overall in-hospital MACCE after DES was similarly lower compared to BMS (3.5% vs. 7.6%, p < 0.001). After adjusting for all confounding covariables, DES remained an independent predictor for lower in-hospital mortality (OR 0.51,95% CI 0.40-0.67, p < 0.001). Since groups differed as regards to baseline characteristics and pharmacological treatment, we performed a propensity score matching (PSM) to limit potential biases. Even after the PSM, DES implantation remained independently associated with a reduced risk of in-hospital mortality (adjusted OR 0.54, 95% CI 0.39-0.76, p < 0.001).
In unselected patients from a nationwide, real-world cohort, we found DES, compared to BMS, was associated with lower in-hospital mortality and MACCE. The identification of optimal treatment strategies of patients with AMI needs further randomised evaluation; however, our findings suggest a potential benefit with DES.
最近，有人提出在直接经皮冠状动脉介入治疗（pPCI）中使用的支架类型可能会影响急性心肌梗死（AMI）患者的预后。事实上，与裸金属支架（BMS）相比，药物洗脱支架（DES）可减少内膜增生。此外，新一代DES由于其生物相容性聚合物涂层和支架设计，具有更好的可输送性，能改善内皮愈合，因此再狭窄和血栓形成较少。然而，关于DES在大量AMI患者中的安全性和性能的数据仍然有限。
比较DES与BMS在AMI患者中的早期预后。
这是一项前瞻性、多中心分析，纳入了2005年至2013年间在瑞士64家医院接受pPCI的AMI患者。主要终点是住院期间全因死亡，次要终点包括死亡、再梗死和脑血管事件的主要不良心脑血管事件（MACCE）综合指标。
在20464例初步诊断为AMI并纳入AMIS Plus注册研究的患者中，15026例接受了pPCI，13442例接受了支架植入。1组094例患者植入了DES，2260例植入了BMS。与植入BMS的患者相比，植入DES的患者住院期间总体死亡率显著更低（2.6%对7.1%，p<0.001）。DES术后住院期间的总体MACCE也低于BMS（3.5%对7.6%，p<0.001）。在对所有混杂协变量进行调整后，DES仍然是住院死亡率较低的独立预测因素（OR 0.51，95%CI 0.40 - 0.67，p<0.001）。由于两组在基线特征和药物治疗方面存在差异，我们进行了倾向评分匹配（PSM）以限制潜在偏倚。即使在PSM之后，DES植入仍然与住院死亡率降低的风险独立相关（调整后OR 0.54，95%CI 0.39 - 0.76，p<0.001）。
在一个全国性、真实世界队列的未选择患者中，我们发现与BMS相比，DES与较低的住院死亡率和MACCE相关。确定AMI患者的最佳治疗策略需要进一步的随机评估；然而，我们的研究结果表明DES可能具有益处。
