Lee Oh-Hyun, Kim Yongcheol, Son Nak-Hoon, Cho Deok-Kyu, Kim Jung-Sun, Kim Byeong-Keuk, Choi Donghoon, Hong Myeong-Ki, Jeong Myung Ho, Jang Yangsoo
Yonsei University College of Medicine Cardiovascular Center, Yongin Severance Hospital, Yongin-si, South Korea.
Data Science Team (Biostatistician), Center for Digital Health, Yongin Severance Hospital, Yongin-si, South Korea.
Front Cardiovasc Med. 2022 May 23;9:880351. doi: 10.3389/fcvm.2022.880351. eCollection 2022.
In patients with ST-elevation myocardial infarction (STEMI) with a high risk of ischemic events, the safety and efficacy of drug-eluting stent (DES) are unclear.
Based on the nationwide, multicenter, prospective registry, we selected 1,592 patients who underwent primary percutaneous coronary intervention (PCI) with everolimus-(EES) and zotarolimus-eluting stent (ZES) for STEMI with a high risk of an ischemic event. The occurrence of target lesion failure (TLF) for 3 years, defined as the composite of cardiac death, target vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR), was evaluated.
The prevalence of high ischemic risk features was observed in 43.4% (2,744/6,325) of overall patients with STEMI. Among them, a total of 1,078 and 514 patients were treated with EES and ZES, respectively. At 3 years, the risk of TLF was not significantly different between the two groups ( = 0.93). In addition, the incidence of cardiac death, TV-MI, ID-TLR, and definite/probable stent thrombosis (ST) were also not different between the two groups. Moreover, elderly patients (age > 75 years) and PCI for the left main disease were identified as independent predictors of TLF.
Implantation of EES or ZES provided comparable clinical outcomes in STEMI patients and high ischemic risks.
在缺血事件风险较高的ST段抬高型心肌梗死（STEMI）患者中，药物洗脱支架（DES）的安全性和有效性尚不清楚。
基于全国多中心前瞻性注册研究，我们选取了1592例因缺血事件风险较高的STEMI而接受依维莫司洗脱支架（EES）和佐他莫司洗脱支架（ZES）的直接经皮冠状动脉介入治疗（PCI）的患者。评估3年时靶病变失败（TLF）的发生率，其定义为心源性死亡、靶血管心肌梗死（TV-MI）和缺血驱动的靶病变血运重建（ID-TLR）的复合情况。
在所有STEMI患者中，43.4%（2744/6325）存在高缺血风险特征。其中，分别有1078例和514例患者接受了EES和ZES治疗。3年时，两组之间TLF风险无显著差异（=0.93）。此外，两组之间心源性死亡、TV-MI、ID-TLR以及明确/可能的支架血栓形成（ST）的发生率也无差异。而且，老年患者（年龄>75岁）和左主干病变的PCI被确定为TLF的独立预测因素。
在STEMI患者及高缺血风险患者中，植入EES或ZES可提供相似的临床结局。
