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新一代药物洗脱支架置入后,当前吸烟者的 ST 段抬高与非 ST 段抬高心肌梗死。

ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation.

机构信息

Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.

Cardiovascular Center, Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea.

出版信息

Medicine (Baltimore). 2021 Dec 10;100(49):e28214. doi: 10.1097/MD.0000000000028214.

Abstract

We compared the 2-year major clinical outcomes between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). The availability of data in this regard is limited.A total of 8357 AMI patients were included and divided into 2 groups: the STEMI group (n = 5124) and NSTEMI group (n = 3233). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), or coronary repeat revascularization. The secondary endpoints were the cumulative incidences of the individual components of MACE and stent thrombosis (definite or probable).After propensity score-matched (PSM) analysis, 2 PSM groups (2250 pairs, C-statistics = 0.795) were generated. In the PSM patients, both for 1 month and at 2 years, the cumulative incidence of MACE (P = .183 and P = .655, respectively), all-cause death, cardiac death, re-MI, all-cause death or MI, any repeat revascularization, and stent thrombosis (P = .998 and P = .341, respectively) was not significantly different between the STEMI and NSTEMI groups. In addition, these results were confirmed using multivariate analysis.In the era of contemporary newer-generation DESs, both during 1 month and at 2 years after index PCI, the major clinical outcomes were not significantly different between the STEMI and NSTEMI groups confined to the patients who are current smokers. However, further research is needed to confirm these results.

摘要

我们比较了在接受新一代药物洗脱支架(DES)成功经皮冠状动脉介入治疗(PCI)的当前吸烟者中,ST 段抬高型心肌梗死(STEMI)与非 ST 段抬高型心肌梗死(NSTEMI)患者的 2 年主要临床结局。在这方面,数据的可用性有限。

共纳入 8357 例 AMI 患者,分为 2 组:STEMI 组(n = 5124)和 NSTEMI 组(n = 3233)。主要终点是主要不良心脏事件(MACE)的发生,定义为全因死亡、再发心肌梗死(re-MI)或冠状动脉再次血运重建。次要终点是 MACE 和支架血栓形成(确定或可能)各组成部分的累积发生率。

经过倾向评分匹配(PSM)分析,生成了 2 个 PSM 组(2250 对,C 统计量=0.795)。在 PSM 患者中,无论是在 1 个月还是 2 年时,MACE(P=0.183 和 P=0.655)、全因死亡、心源性死亡、再发心肌梗死、全因死亡或心肌梗死、任何再次血运重建和支架血栓形成(P=0.998 和 P=0.341)的累积发生率在 STEMI 和 NSTEMI 组之间均无显著差异。此外,这些结果在多变量分析中得到了证实。

在当代新一代 DES 时代,在索引 PCI 后 1 个月和 2 年时,在仅限于当前吸烟者的患者中,STEMI 和 NSTEMI 两组的主要临床结局没有显著差异。然而,需要进一步的研究来证实这些结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/440d/8663858/546fa84b956b/medi-100-e28214-g001.jpg

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