在来自HORIZONS-AMI、TAXUS IV和V以及ATLAS主力、长病变和直接支架研究的汇总血管内超声分析中，ST段抬高型心肌梗死的支架置入与较少的新生内膜增生相关。
Stenting for ST-segment elevation myocardial infarction is associated with less neointimal hyperplasia in the pooled IVUS analysis from HORIZONS-AMI and the TAXUS IV and V and ATLAS workhorse, long lesion, and direct stent studies.
作者信息
Kobayashi Nobuaki, Maehara Akiko, Allocco Dominic, Witzenbichler Bernard, Ellis Stephen G, Turco Mark A, Ormiston John A, Guagliumi Giulio, Jiang Songtao, McAndrew Thomas C, Dawkins Keith D, Stone Gregg W, Mintz Gary S, Weissman Neil J
机构信息
aNew York Presbyterian Hospital/Columbia University Medical Center bClinical Trials Center, Cardiovascular Research Foundation, New York, New York cBoston Scientific Corporation, Natick, Massachusetts dDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio eVascular Therapies, Covidien fGeorgetown University, Washington, District of Columbia gMedStar Health Research Institute, Hyattsville, Maryland, USA hAmper Kliniken AG, Dachau, Germany iCardiology Department, Auckland City Hospital, Auckland, New Zealand jInterventional Cardiology Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
出版信息
Coron Artery Dis. 2014 Nov;25(7):575-81. doi: 10.1097/MCA.0000000000000131.
OBJECTIVE
To investigate the difference in neointimal hyperplasia (NIH) between ST-segment elevation myocardial infarction (STEMI), stable angina pectoris (SAP), and unstable angina pectoris (UAP).
PATIENTS AND METHODS
From formal core laboratory intravascular ultrasound substudies, we compared NIH after paclitaxel-eluting stents (PES) or bare metal stents (BMS) in STEMI lesions from HORIZONS-AMI trial with SAP and UAP lesions from TAXUS IV, V, and ATLAS studies.
RESULTS
At follow-up, %NIH at the minimum lumen area (MLA) site was less in STEMI (n=212) than in UAP (n=233) and SAP (n=440) lesions treated with PES (19.6 vs. 26.2 vs. 25.0%, P=0.002; all intravascular ultrasound data shown as least-square means in abstract) and less in STEMI (n=66) than in UAP (n=72) and SAP (n=143) lesions treated with BMS (34.0 vs. 26.7 vs. 45.5%, P=0.0003). As a result, MLA at follow-up was larger in STEMI than in UAP and SAP lesions treated with PES (5.9 vs. 5.2 vs. 5.0 mm, P<0.0001) or treated with BMS (5.1 vs. 4.3 vs. 4.0 mm, P=0.002). Net volume obstruction ([NIH/stent volume]×100) at follow-up was significantly less in STEMI than in UAP and SAP lesions treated with PES (7.8 vs. 13.4 vs. 13.4%, P<0.0001) or BMS (20.6 vs. 28.5 vs. 32.1%, P<0.0001). Multivariate linear regression analysis showed that STEMI was correlated independently and inversely with net volume obstruction compared with SAP (regression coefficient -6.99, P<0.0001) or UAP (regression coefficient -6.29, P<0.0001).
CONCLUSION
Implantation of PES or BMS in STEMI compared with UAP and SAP was associated with less NIH.
目的
探讨ST段抬高型心肌梗死（STEMI）、稳定型心绞痛（SAP）和不稳定型心绞痛（UAP）患者内膜增生（NIH）的差异。
患者和方法
我们从正式的核心实验室血管内超声亚研究中，将HORIZONS-AMI试验中STEMI病变植入紫杉醇洗脱支架（PES）或裸金属支架（BMS）后的NIH，与TAXUS IV、V和ATLAS研究中SAP和UAP病变植入后的NIH进行比较。
结果
随访时，PES治疗的STEMI病变（n = 212）最小管腔面积（MLA）部位的NIH百分比低于UAP病变（n = 233）和SAP病变（n = 440）（分别为19.6%、26.2%和25.0%，P = 0.002；摘要中所有血管内超声数据均以最小二乘法均值表示），BMS治疗的STEMI病变（n = 66）最小管腔面积部位的NIH百分比低于UAP病变（n = 72）和SAP病变（n = 143）（分别为34.0%、26.7%和45.5%，P = 0.0003）。结果，随访时STEMI病变植入PES或BMS后的MLA大于UAP和SAP病变（分别为5.9、5.2和5.0mm，P < 0.0001；5.1、4.3和4.0mm，P = 0.002）。随访时，STEMI病变的净容积阻塞率（[NIH/支架容积]×100）显著低于UAP和SAP病变植入PES或BMS后的水平（分别为7.8%、13.4%和13.4%，P < 0.0001；20.6%、28.5%和32.1%，P < 0.0001）。多变量线性回归分析显示，与SAP（回归系数 -6.99，P < 0.0001）或UAP（回归系数 -6.29，P < 0.0001）相比，STEMI与净容积阻塞率独立且呈负相关。
结论
与UAP和SAP相比，STEMI患者植入PES或BMS后的NIH较少。
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