急性ST段抬高心肌梗死患者应用进口及国产雷帕霉素洗脱支架疗效分析

Curative effect of foreign and sino sirolimus-eluting stents in emergency percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

目的观察进口及国产雷帕霉素洗脱支架（Cypher与Firebird）在急性ST段抬高心肌梗死（ST—segment elevation myocardial infarcation，STEMI）急诊经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）中的疗效及安全性。方法选择有ST段抬高或新出现左束支传导阻滞（LBBB）急性心肌梗死、发病在12小时内或虽时间大于12小时但症状持续存在者302例；随机分为3组，即裸支架（bare metal stent，BMS）组98例、Cypher支架组103例和Firebird支架组101例；随访6～9个月，比较3组支架术后近期及远期疗效。结果支架植入术前3组患者临床指标及冠状动脉病变情况比较差异均无统计学意义，术后住院及随访过程中主要不良心脏事件（major adverse cardiac events，MACE）发生率比较差异无统计学意义；复查冠状动脉造影，3组靶血管再狭窄率、血运重建率比较差异无统计学意义；3组支架内最小管腔内径（2．73±0．36）mm vs（2．95±0．19）mm、（2．94±0．20）mm，节段内最小管腔内径（2．61±0．29）mm vs（2．884±0．23）mm、（2．89±0．19）mm，支架内晚期管腔丢失（0．28±0．11）mm vs（0．03±0．09）mm、（0．04±0．10）mm，节段内晚期管腔丢失（0．254±0．17）mm vs（0．08±0．12）mm、（0．10±0．15）mm，裸支架组与Cypher支架组及Firebird支架组比较差异均有统计学意义（P〈0．05或P〈0．01），而Cypher支架组及Firebird支架组比较差异均无统计学意义（P〉0．05）。结论雷帕霉素药物涂层支架（Cypher与Firebird）在急性ST段抬高心肌梗死（STEMI）患者急诊PCI中应用是安全有效的，较裸支架可明显减少管腔狭窄，降低支架内及节段内晚期管腔丢失；进口及国产雷帕霉素药物涂层支架（Cypher与Fireblrd）具有相同的临床疗效。

Objective To evaluate the efficacy and safety of foreign and sino sirolimus-eluting stents （Cypher and Firebird） in emergency percutaneous coronary intervention（PCI） in patients with ST-segment elevation myocardial infarction（STEMI）. Methods Acute myocardial infarction（AMI） patients with ST-segment elevation or new-found LBBB were enrolled,all of which suffered from the disease attack within 12 hours or continued symptoms beyond 12 hours. The patients were divided into three groups：bare metal stent（BMS） group, Cypher stent group, Firebird stent group. The followed-up was 6 9 months to compare the efficacy and safety of different stents. Results The clinical data of the patients and coronary arteriography（CAG） results were of no statistical differences. During post-operation hospitalized period and follow-up, the major adverse cardiac events ratios of three groups as of no statistical differences. According to CAG re-examination of three groups, in-stent minimal lumen diameter（MLD） （2.73 ± 0.36） mm vs （2.95±0.19） mm,（2. 94±0. 20） mm,in-segment MLD（2. 61±0. 29） mm vs （2.88±0.23） mm,（2.89±0.19） mm, in-stent late lumen loss（LLL） （0.28±0.11） mm vs （0.03±0.09） mm, （0.04±0.10） mm,in-segment LLL（0. 25± 0.17） mm vs （0.08±0.12） mm, （0.10±0.15） ram, showed Cypher stent group and Firebird stent group were of no differences （ P 〉0. 05） ,while the bare metal stent（BMS） group was of statistical difference with other two groups （P 〈 0.05 or P 〈0.01）. Conclusion Sirolimus-eluting stents （both Cypher and Firebird） in emergency PCI in STEMI patients are safe and efficient. Compared with bare metal stent, Sirolimus-eluting stent can evidently reduce vessel stenosis, and decrease in-stent and in-segment LLL. Foreign and sino Sirolimus- eluting stents （Cypher and Firebird） are of no evident differences in terms of safety and efficacy.