Department of Cardiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
EuroIntervention. 2017 Jul 20;13(4):397-406. doi: 10.4244/EIJ-D-16-00653.
The aim of this study was to demonstrate the feasibility and safety of ST-elevation myocardial infarction (STEMI) management in young patients by limiting implantation of durable intracoronary devices (using a bioresorbable stent or medical treatment alone).
Patients <50 years old admitted for STEMI with single-vessel disease received a two-stage management strategy. During a second coronary angiography performed between day 2 and day 7, optical frequency domain imaging (OFDI) guided the decision on therapeutic management, i.e., i) in the case of a stenosis greater than 70% or plaque prolapse, implantation of a BVS; or ii) in the other cases, continuation of medical management alone without stenting. All patients underwent systematic angiographic control with OFDI imaging at six months. Among the 653 patients admitted for STEMI, 124 patients were under 50 years old and 45 patients were included. Early management was performed on average at day 3.9 (day 2 - day 7). Thirty-four (34) patients received BVS implantation and 11 were treated medically. Only one major adverse cardiac event (MACE) had occurred at six months.
In a selected younger population, the management of STEMI guided by OFDI and based on the concept of limiting implantation of durable intracoronary devices appears to be a feasible and safe therapeutic option.
本研究旨在通过限制永久性冠状动脉内装置的植入（使用生物可吸收支架或单纯药物治疗）来证明年轻患者 ST 段抬高型心肌梗死（STEMI）管理的可行性和安全性。
因单支血管病变而入院的年龄<50 岁的 STEMI 患者接受了两阶段管理策略。在第 2 天至第 7 天之间进行的第二次冠状动脉造影中，采用光频域成像（OFDI）指导治疗管理决策，即 i）如果存在大于 70%的狭窄或斑块脱垂，则植入 BVS；或 ii）在其他情况下，单纯继续药物治疗而不进行支架置入。所有患者均在 6 个月时接受了 OFDI 成像的系统血管造影控制。在因 STEMI 而入院的 653 例患者中，有 124 例年龄<50 岁，其中 45 例被纳入研究。早期管理平均在第 3.9 天（第 2 天至第 7 天）进行。34 例患者接受了 BVS 植入，11 例接受了药物治疗。仅在 6 个月时发生 1 例主要不良心脏事件（MACE）。
在选择的年轻人群中，基于限制永久性冠状动脉内装置植入概念并由 OFDI 指导的 STEMI 管理似乎是一种可行且安全的治疗选择。
