Sato Nobuhiro, Minami Yoshiyasu, Shimohama Takao, Kameda Ryo, Tojo Taiki, Ako Junya
Department of Cardiovascular Medicine Kitasato University Hospital Sagamihara Japan.
Health Sci Rep. 2018 Dec 5;2(1):e105. doi: 10.1002/hsr2.105. eCollection 2019 Jan.
Second-generation drug-eluting stents (G2-DES) are associated with a lower rate of acute and subacute stent thrombosis compared with bare-metal stent (BMS) in the setting of ST-segment elevation myocardial infarction (STEMI). In this study, our aim was to compare the vascular response and thrombus burden between G2-DES and BMS in early-phase STEMI.
Between May 2010 and August 2014, a total of 41 STEMI patients treated by either G2-DES (n = 26; everolimus-eluting stent [EES]: n = 15, zotarolimus-eluting stent [ZES]: n = 11) or BMS (n = 15) and, with multivessel disease requiring additional percutaneous coronary intervention (PCI), were prospectively enrolled. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation.
Baseline clinical characteristics, except for age (61.5 ± 9.3 vs 69.3 ± 9.8, = 0.01, test), were comparable between patients with drug-eluting stent (DES) and BMS. The incidence of residual thrombus after the stent implantation for STEMI was comparable between DES and BMS (7.7% vs 6.7%, = 0.88, test). At 1 month, thrombus burden, defined as the mean thrombus area divided by the mean lumen area, was significantly smaller with DES than with BMS (median interquartile range (IQR), 1.2 (0.0, 1.0) vs 1.2 (0.0, 2.2), = 0.04, Mann-Whitney test), despite a similar percentage of malapposed (median (IQR), 6.2 (2.4, 9.0) vs 2.6 (0.0, 5.8)%, = 0.07, Mann-Whitney test) or uncovered struts (median (IQR), 6.8 (1.8, 13.1) vs 6.14 (2.8, 18.5)%, = 0.45, Mann-Whitney test). No significant difference in thrombus burden was observed between EES and ZES.
Thrombus burden was significantly smaller with DES than with BMS at 1-month follow-up in STEMI cases, although the percentage of malapposed or uncovered struts was similar between the groups. This may partly explain the lower rate of acute and subacute stent thrombosis in G2-DES that has previously been reported in the literature.
在ST段抬高型心肌梗死（STEMI）患者中，与裸金属支架（BMS）相比，第二代药物洗脱支架（G2-DES）发生急性和亚急性支架内血栓形成的几率较低。在本研究中，我们旨在比较早期STEMI患者中G2-DES和BMS的血管反应及血栓负荷。
2010年5月至2014年8月期间，前瞻性纳入了41例接受G2-DES（n = 26；依维莫司洗脱支架[EES]：n = 15，佐他莫司洗脱支架[ZES]：n = 11）或BMS（n = 15）治疗且有多支血管病变需要额外经皮冠状动脉介入治疗（PCI）的STEMI患者。在支架植入后1个月进行光学相干断层扫描（OCT）成像。
除年龄外（61.5±9.3对69.3±9.8，P = 0.01，t检验），药物洗脱支架（DES）组和BMS组患者的基线临床特征具有可比性。STEMI患者支架植入后残余血栓的发生率在DES组和BMS组之间相当（7.7%对6.7%，P = 0.88，χ²检验）。在1个月时，定义为平均血栓面积除以平均管腔面积的血栓负荷，DES组显著小于BMS组（中位数四分位间距[IQR]，1.2（0.0，1.0）对1.2（0.0，2.2），P = 0.04，Mann-Whitney U检验），尽管贴壁不良（中位数[IQR]，6.2（2.4，9.0）对2.6（0.0，5.8）%，P = 0.07，Mann-Whitney U检验）或未覆盖支架（中位数[IQR]，6.8（1.8，13.1）对6.14（2.8，18.5）%，P = 0.45，Mann-Whitney U检验）的比例相似。EES和ZES之间的血栓负荷未观察到显著差异。
在STEMI病例中，1个月随访时DES组的血栓负荷显著小于BMS组，尽管两组之间贴壁不良或未覆盖支架的比例相似。这可能部分解释了先前文献中报道的G2-DES急性和亚急性支架内血栓形成发生率较低的原因。
