STEMI 后延迟支架置入患者的心肌损伤：DANAMI-3-DEFER 亚研究。
Myocardial Damage in Patients With Deferred Stenting After STEMI: A DANAMI-3-DEFER Substudy.
机构信息
Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
出版信息
J Am Coll Cardiol. 2017 Jun 13;69(23):2794-2804. doi: 10.1016/j.jacc.2017.03.601.
BACKGROUND
Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3-DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and deferred stenting.
OBJECTIVES
This study sought to evaluate the effect of deferred stent implantation on infarct size, myocardial salvage, and microvascular obstruction (MVO) in patients with STEMI.
METHODS
In the present DANAMI-3 substudy, a total of 510 patients with STEMI were randomized to PCI with deferred versus immediate stent implantation. The patients underwent a cardiac magnetic resonance examination before discharge after the index procedure and again 3 months later. The primary endpoint was final infarct size.
RESULTS
Deferred stenting did not reduce final infarct size (9% left ventricle [LV]; interquartile range [IQR]: 3% to 18% vs. 10% LV; IQR: 3% to 18%; p = 0.67). Similarly, deferred stenting was not associated with myocardial salvage index (66%; IQR: 50% to 89% vs. 67%; IQR: 49% to 88%; p = 0.80) or presence of MVO (43% vs. 42%; p = 0.78). In a post hoc analysis, stent length was the only subgroup of 7 that had an effect on outcome. In patients with a stent length ≥24 mm, deferred stenting reduced the final infarct size (6% LV; IQR: 2% to 18% vs. 13% LV; IQR: 7% to 23%; p = 0.006; and p for interaction = 0.005).
CONCLUSIONS
In the DANAMI-3-DEFER cardiac magnetic resonance substudy, routine deferred stenting did not reduce infarct size or MVO and did not increase myocardial salvage. These results do not support the use of routine deferred stenting in STEMI patients treated with primary PCI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408).
背景
尽管一些研究发现，在进行支架植入时推迟可以改善冠状动脉血流和心肌挽救，但 DANAMI-3-DEFER（第三项丹麦急性 ST 段抬高型心肌梗死患者最佳治疗研究）并未显示在接受直接经皮冠状动脉介入治疗（PCI）和延迟支架置入的 ST 段抬高型心肌梗死（STEMI）患者中，临床结局有任何改善。
目的
本研究旨在评估在 STEMI 患者中延迟支架植入对梗死面积、心肌挽救和微血管阻塞（MVO）的影响。
方法
在目前的 DANAMI-3 子研究中，共有 510 例 STEMI 患者被随机分为接受 PCI 并延迟或即刻支架植入。患者在指数手术后出院前和 3 个月后进行心脏磁共振检查。主要终点是最终梗死面积。
结果
延迟支架置入并未减少最终梗死面积（左心室 9%；四分位间距 [IQR]：3%18% vs. 左心室 10%；IQR：3%18%；p=0.67）。同样，延迟支架置入与心肌挽救指数（66%；IQR：50%89% vs. 67%；IQR：49%88%；p=0.80）或 MVO 的存在（43% vs. 42%；p=0.78）也无关。在事后分析中，支架长度是唯一有影响的亚组。在支架长度≥24mm 的患者中，延迟支架置入减少了最终梗死面积（左心室 6%；IQR：2%18% vs. 左心室 13%；IQR：7%23%；p=0.006；p 交互=0.005）。
结论
在 DANAMI-3-DEFER 心脏磁共振子研究中，常规延迟支架置入并未减少梗死面积或 MVO，也未增加心肌挽救。这些结果不支持在接受直接 PCI 治疗的 STEMI 患者中常规使用延迟支架置入。（丹麦急性 ST 段抬高型心肌梗死患者最佳治疗研究 [DANAMI-3]；NCT01435408）。
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