Viveiros Monteiro A, Ramos R, Fiarresga A, de Sousa L, Cacela D, Patrício L, Bernardes L, Soares C, Cruz Ferreira R
Cardiology Department, Hospital of Santa Marta, Rua de Santa Marta, 1169-1024, Lisbon, Portugal.
Herz. 2017 Apr;42(2):186-193. doi: 10.1007/s00059-016-4446-0. Epub 2016 Jun 30.
In patients recovering from an ST-segment elevation myocardial infarction (STEMI), it is not clear whether the negative impact of stent thrombosis (ST) is different from a non-stent-related recurrent myocardial infarction (NSRMI). This study sought to assess the long-term incidence and prognostic impact of recurrent myocardial infarction (MI) after percutaneous coronary intervention (PCI) for STEMI by comparing outcomes of ST versus NSRMI.
From 2001 to 2007, 1025 patients undergoing PCI for STEMI were prospectively followed up. Patients with ST, with NSRMI, and those free from recurrent MI were compared regarding mortality and major adverse cardiac and cerebrovascular events (MACCE).
Recurrent MI decreased from 37 events per 1000 person/months in the first month to 3.3 events per 1000 person/months after the first year. The cumulative 5‑year incidence of ST and NSRMI was 5.27 % and 13.2 %, respectively. MACCE at 60 months after recurrence were not significantly different for patients with reinfarction but were significantly higher than for patients free from any recurrent MI (both log-rank p < 0.001). However, the cumulative all-cause death rate did not differ between the three groups (27.8 vs. 26.7 vs. 23.0 %). Compared with ST occurring in the first 30 days after PCI for STEMI, early NSRMI was associated with a significantly reduced risk for all-cause death (HR, 0.21; 95 % CI, 0.33-3.30) but this association did not persist for recurrent MIs occurring in the late (HR, 1.05; 95 % CI, 0.33-3.30) or very late follow-up periods.
Although ST was associated with a significant increase in adverse events in the early recovery period, in the long term, MACCE and all-cause mortality rates were comparable to those for NSRMI.
在ST段抬高型心肌梗死（STEMI）恢复过程中的患者中，支架内血栓形成（ST）的负面影响是否与非支架相关复发性心肌梗死（NSRMI）不同尚不清楚。本研究旨在通过比较ST与NSRMI的结果，评估STEMI经皮冠状动脉介入治疗（PCI）后复发性心肌梗死（MI）的长期发生率及预后影响。
对2001年至2007年期间接受STEMI PCI治疗的1025例患者进行前瞻性随访。比较发生ST、NSRMI以及无复发性MI的患者的死亡率和主要不良心脑血管事件（MACCE）。
复发性MI从第一个月的每1000人/月37例事件降至第一年之后的每1000人/月3.3例事件。ST和NSRMI的累积5年发生率分别为5.27%和13.2%。复发后60个月时，再梗死患者的MACCE无显著差异，但显著高于无任何复发性MI的患者（对数秩检验p均<0.001）。然而，三组的累积全因死亡率无差异（27.8%对26.7%对23.0%）。与STEMI PCI术后前30天发生的ST相比，早期NSRMI与全因死亡风险显著降低相关（HR，0.21；95%CI，0.33 - 3.30），但这种关联在晚期（HR，1.05；95%CI，0.33 - 3.30）或极晚期随访期发生的复发性MI中并不持续。
尽管ST在早期恢复期与不良事件显著增加相关，但从长期来看，MACCE和全因死亡率与NSRMI相当。
