糖尿病急性ST段抬高心肌梗死应用雷帕霉素药物洗脱支架1年随访分析

The application and one-year follow-up result of sirolimus-eluting stent in diabetic patients with ST-segment elevation myocardial infarction.

目的探讨雷帕霉素药物洗脱支架在糖尿病急性ST段抬高心肌梗死(STEMI)患者急诊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2002年11月至2005年10月间首都医科大学附属北京朝阳医院心脏中心收治的糖尿病急性STEMI患者106例,于发病12h内行急诊PCI治疗,置入雷帕霉素药物洗脱支架。记录术后1个月和12个月随访终点时的心血管事件发生率、支架内血栓发生率及支架内再狭窄发生率。结果105例患者急诊PCI治疗获得成功。106支梗塞相关血管(IRA)的110处罪犯病变处置入雷帕霉素药物洗脱支架134枚,未发生与介入治疗有关的并发症。1个月随访终点时死亡4例(3.77%),发生急性心肌梗死1例,心血管事件总发生率为4.72%;发生支架内血栓1例;血运重建1例。12个月随访终点时除1个月时死亡的4例外未再发生死亡病例,共发生心血管事件11例(10.38%),发生支架内血栓2例(1.89%),52例接受冠状动脉造影复查患者中发生支架内再狭窄6例(11.54%)。结论雷帕霉素药物洗脱支架在STEMI急诊PCI中应用有较高的安全性和有效性,并可以明显降低再狭窄率。

Objective To investigate the feasibility, safety and efficacy of slrolimus-eluting stent implanting in diabetic patients with ST-segment elevation myocardial infarction（STEMI） treated by emergency percutaneous coronary intervention （PCI）. Methods One hundred and six diabetic patients with STEMI treated by emergency PCI were included into this study. The incidence of major adverse cardiovascular event （MACE） , stent thrombosis and restenosis was evaluated. Results Totally 105 patients were successfully treated by emergency PCI and there were no complication during the procedure. Totally 134 sirolimus：eluting stents were successfully implanted on 110 target lesions. There was one subacute stent thrombosis in 106 patients during one month. One-month follow-up result showed that the MACE was 4. 72% and the death rate was 3.77%. The MACE was 10. 38% and the death rate was 3.77% one year later. One-year angiography follow-up showed that restenosis rate was 11.54%. Conclusion Implanting sirolimus-eluting stent in STEMI patients during emergency PCI is safe and effective. Sirolimus-eluting stent can reduce restenosis rate and MACE in diabetic patients with STEMI treated by emergency PCI.