Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taiwan; Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan.
Atherosclerosis. 2021 Jan;316:84-89. doi: 10.1016/j.atherosclerosis.2020.10.012. Epub 2020 Oct 10.
The association between implanted stent types and heart failure in patients with non-ST-elevation myocardial infarction (NSTEMI) remains unknown. The current study aimed to investigate whether the implantation of a newer-generation drug-eluting stent (NG-DES) compared with that of a bare-metal stent (BMS) in patients with NSTEMI who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF).
In this nationwide, population-based retrospective cohort study, propensity score matching was used on the Taiwan's National Health Insurance Research Database to select 8,644 pairs of patients with NSTEMI and similar baseline characteristics receiving NG-DES or BMS implantation between January 1, 2007 and December 31, 2016. A competing risk model was constructed to evaluate the risk of HHF in the NG-DES and BMS groups. Death was considered a competing risk.
Rates of cumulative incidence competing risk for HHF at 1, 2, 3, 4, and 5-year follow-ups were lower in the NG-DES group (4.11%, 5.63%, 6.72%, 7.65%, and 8.89%, respectively) than in the BMS group (5.89%, 7.81%, 9.25%, 10.8%, and 11.9%, respectively). After adjustment for all clinical variables, NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.71 (95% CI = 0.64-0.79, p < 0.001). These results are in agreement with those of patients who received DAPT for >6 months.
NG-DESs may reduce HHF risk in patients with NSTEMI who receive an undefined duration of DAPT.
非 ST 段抬高型心肌梗死（NSTEMI）患者植入支架类型与心力衰竭之间的关系尚不清楚。本研究旨在探讨 NSTEMI 患者接受未定义时长双联抗血小板治疗（DAPT）时，与植入裸金属支架（BMS）相比，植入新一代药物洗脱支架（NG-DES）是否降低心力衰竭（HHF）住院风险。
本全国性基于人群的回顾性队列研究使用倾向评分匹配，从 2007 年 1 月 1 日至 2016 年 12 月 31 日的台湾全民健康保险研究数据库中选择了 8644 对接受 NG-DES 或 BMS 植入的 NSTEMI 患者，这些患者具有相似的基线特征。构建竞争风险模型以评估 NG-DES 和 BMS 组 HHF 的风险。死亡被视为竞争风险。
在 1、2、3、4 和 5 年随访时，NG-DES 组的 HHF 累积发生率竞争风险分别为 4.11%、5.63%、6.72%、7.65%和 8.89%，低于 BMS 组的 5.89%、7.81%、9.25%、10.8%和 11.9%。在调整所有临床变量后，与 BMS 植入相比，NG-DES 植入在 5 年后与 HHF 风险降低相关，调整后的亚分布危险比为 0.71（95%CI=0.64-0.79，p<0.001）。这些结果与接受 >6 个月 DAPT 的患者的结果一致。
在接受未定义时长 DAPT 的 NSTEMI 患者中，NG-DES 可能降低 HHF 风险。
