Suryapranata H, van 't Hof A W, Hoorntje J C, de Boer M J, Zijlstra F
Department of Cardiology, Hospital De Weezenlanden, Zwolle, The Netherlands.
Circulation. 1998 Jun 30;97(25):2502-5. doi: 10.1161/01.cir.97.25.2502.
Although the benefits of primary angioplasty in acute myocardial infarction have been demonstrated, several areas for improvement remain. Therefore, a prospective randomized trial comparing primary stenting with balloon angioplasty in patients with acute myocardial infarction was conducted.
Patients with acute myocardial infarction were randomly assigned to undergo either primary stenting (n=112) or balloon angioplasty (n=115). The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the infarct-related vessel. The overall mortality rate at 6 months was 2%. Recurrent infarction occurred in 8 patients (7%) after balloon angioplasty and in 1 (1%) after stenting (P=0.036). Subsequent target-vessel revascularization was necessary in 19 (17%) and 4 (4%) patients, respectively (P=0.0016). The cardiac event-free survival rate in the stent group was significantly higher than in the balloon angioplasty group (95% versus 80%; P=0.012).
In selected patients with acute myocardial infarction, primary stenting can be applied safely and effectively, resulting in a lower incidence of recurrent infarction and a significant reduction in the need for subsequent target-vessel revascularization compared with balloon angioplasty.
尽管直接血管成形术在急性心肌梗死中的益处已得到证实，但仍有几个需要改进的方面。因此，开展了一项前瞻性随机试验，比较急性心肌梗死患者直接支架置入术与球囊血管成形术的效果。
急性心肌梗死患者被随机分配接受直接支架置入术（n = 112）或球囊血管成形术（n = 115）。临床终点为死亡、再发梗死、随后的搭桥手术或梗死相关血管的再次血管成形术。6个月时的总死亡率为2%。球囊血管成形术后8例（7%）发生再发梗死，支架置入术后1例（1%）发生再发梗死（P = 0.036）。分别有19例（17%）和4例（4%）患者需要随后进行靶血管血运重建（P = 0.0016）。支架组无心脏事件生存率显著高于球囊血管成形术组（95%对80%；P = 0.012）。
在选定的急性心肌梗死患者中，直接支架置入术可安全有效地应用，与球囊血管成形术相比，再发梗死发生率更低，随后靶血管血运重建的需求显著减少。
