药物洗脱支架在急性ST段抬高型心肌梗死中的应用

Drug-Eluting Stent Implantation in ST-Elevation Acute Myocardial Infarction

目的:探讨药物洗脱支架(DES)在急性ST段抬高型心肌梗死(AMI)直接经皮冠状动脉介入治疗(PCI)中应用的安全性和有效性。方法:选择2005年5月—2005年10月间的ST段抬高型AMI患者67例,在发病12h内行急诊PCI治疗,于梗死相关血管(IRA)的靶病变植入DES。术后前瞻性随访300d,观察主要心血管不良事件(MACE)(包括死亡、非致死性再梗和靶血管血运重建)的发生情况。结果:67例患者中,伴糖尿病者占20．9%,多支病变者占71．6%。67例患者共植入84枚DES,64例(95．5%)术终血流达到TIMI-3级。住院期间4例(6．0%)患者死亡,1例(1．5%)术后当天发生早期支架内血栓形成引起非致死性再梗而行靶血管再次血运重建。出院至术后300d随访期间,2例(3．0%)死亡,无一例发生晚期支架内血栓形成、非致死性再梗或因造影或临床再狭窄需行靶血管再次血运重建。结论:DES应用于ST段抬高型AMI患者具有良好的安全性,而且可以明显降低靶血管血运重建的发生率,改善患者远期预后。

Objective：To assess the safety and efficacy of drug-eluting stents （DES） implantation in primary percutaneous coronary intervention （PCI） for patients with ST-segment elevation aeute myocardial infarction （AMI）, Methods：From May 2005 to October 2005, 67 patients with ST-elevation AMI underwent primary PCI and DES implantation and these patients comprise the study population. The incidence of major adverse cardiac events （death, nonfatal myocardial infarction, reintervention） was evaluated. Results.. At baseline, diabetes mellitus was present in 20.9o/oo and multivessel disease in 71.6%. Postprocedural TIMI-3 flow was achieved in 95.5 % of the cases. In-hospital mortality was 6.0%. One patient （1.5 % ） had reinfarction and target lesion reintervention the first day as a result of early documented stent thrombosis. During 300-day follow-up, 2 Patients （3.0~） died, no patient had recurrent myocardial infarction, and there were no additional reinterventions. No late stent thrombosis was documented. Conclusion： In this study, DES implantation for patients with ST-elevation acute myocardial infarction was safe without documented target vessel reintervention at a long-time follow-up.