Kim Yong Hoon, Her Ae-Young, Jeong Myung Ho, Kim Byeong-Keuk, Hong Sung-Jin, Shin Dong-Ho, Kim Jung-Sun, Ko Young-Guk, Choi Donghoon, Hong Myeong-Ki, Jang Yangsoo
Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, 156 Baengnyeong Road, Chuncheon, Gangwon, 24289, South Korea.
Chonnam National University Hospital, Gwangju, Republic of Korea.
Heart Vessels. 2019 Feb;34(2):237-250. doi: 10.1007/s00380-018-1251-0. Epub 2018 Aug 30.
There are limited data comparing the clinical outcomes among new-generation drug-eluting stents (DES) in acute myocardial infarction (AMI) patients with dyslipidemia after percutaneous coronary intervention (PCI). We thought to investigate 2-year clinical outcomes among durable-polymer (DP)-coated stents [zotarolimus eluting (ZES) and everolimus eluting (EES)] and biodegradable-polymer (BP)-coated biolimus-eluting stent (BES) in dyslipidemic AMI patients after PCI. Finally, a total 2403 enrolled patients were divided into ZES (n = 953), EES (n = 1145) or BES (n = 305) group. The primary endpoint was major adverse cardiac events (MACE) defined as total death (TD), cardiac death (CD), myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR) and non-TVR. The secondary endpoint was the incidence of definite or probable stent thrombosis (ST). The 2-year adjusted hazard ratio (HR) of MACE for ZES vs. EES [HR, 1.066; 95% confidence interval (CI) 0.752-1.511; p = 0.720], ZES vs. BES (HR 0.933; 95% CI 0.565-1.541; p = 0.786), EES vs. BES (HR 1.876; 95% CI 0.535-1.436; p = 0.600) and ZES/EES vs. BES (HR 0.929; 95% CI 0.591-1.462; p = 0.751) was similar. The cumulative incidences of ST were comparable (ZES vs. EES vs. BES = 1.1% vs. 0.9% vs. 1.1%, p = 0.675) and adjusted HR was not different. In addition, the 2-year adjusted HR of TD, CD, MI, TLR, TVR, and non-TVR was similar. The AMI patients with dyslipidemia receiving ZES, EES, or BES after PCI showed comparable safety and efficacy during 2-year follow-up periods. Therefore, DP-DES or BP-DES is equally acceptable in dyslipidemic AMI patients during PCI.
在经皮冠状动脉介入治疗(PCI)后患有血脂异常的急性心肌梗死(AMI)患者中,比较新一代药物洗脱支架(DES)临床结局的数据有限。我们想研究在PCI后血脂异常的AMI患者中,耐用聚合物(DP)涂层支架[佐他莫司洗脱(ZES)和依维莫司洗脱(EES)]与可生物降解聚合物(BP)涂层的生物雷帕霉素洗脱支架(BES)的2年临床结局。最终,总共2403名入组患者被分为ZES组(n = 953)、EES组(n = 1145)或BES组(n = 305)。主要终点是主要不良心脏事件(MACE),定义为全因死亡(TD)、心源性死亡(CD)、心肌梗死(MI)、靶病变血管重建(TLR)、靶血管血管重建(TVR)和非TVR。次要终点是明确或可能的支架血栓形成(ST)的发生率。ZES与EES比较MACE的2年调整风险比(HR)[HR,1.066;95%置信区间(CI)0.752 - 1.511;p = 0.720],ZES与BES比较(HR 0.933;95% CI 0.565 - 1.541;p = 0.786),EES与BES比较(HR 1.876;95% CI 0.535 - 1.436;p = 0.600)以及ZES/EES与BES比较(HR 0.929;95% CI 0.591 - 1.462;p = 0.751)均相似。ST的累积发生率相当(ZES与EES与BES = 1.1%与0.9%与1.1%,p = 0.675)且调整后的HR无差异。此外,TD、CD、MI、TLR、TVR和非TVR的2年调整HR相似。PCI后接受ZES、EES或BES治疗的血脂异常AMI患者在2年随访期间显示出相当的安全性和有效性。因此,在PCI期间,DP - DES或BP - DES在血脂异常的AMI患者中同样可以接受。