西罗莫司洗脱支架与裸金属支架治疗急性心肌梗死患者的疗效比较

Stent Restenosis and Reocclusion of Primary Sirolimus-eluting Stents Compared to Bare Stents in Patients with Acute Myocardial Infarction

目的:比较急性心肌梗死(AMI)患者应用西罗莫司洗脱支架(SES)与裸金属支架(BMS)植入术后支架内再狭窄发生率、再闭塞发生率以及临床预后的差异。方法:498例行直接冠心病介入治疗(PCI)的AMI患者分为西罗莫司洗脱支架组(225例)和裸金属支架组(273例),比较两组主要不良心脏事件(包括再次心肌梗死、缺血性靶血管重建和死亡)发生率及再狭窄率和再闭塞率的差异,分析支架再狭窄和闭塞患者所出现的心脏事件发生有无不同。结果:平均随访时间8个月,SES组的主要不良心脏事件(MACE)发生率、支架内再狭窄率以及节段内再狭窄率均显著低于BMS组,依次为5.6%比12.6%(P<0.01)、1.3%比8.9%(P<0.01)和2.7%比9.5%(P<0.01);再发心肌梗死和心脏性死亡的发生率两组无显著差异。两组急性支架闭塞率及其导致的临床预后无显著差异(P>0.05),主要表现为再次急性心肌梗死,并需要再次靶血管重建。而支架再狭窄和慢性闭塞患者所出现的心脏事件方面,SES组的缺血性靶血管重建、不稳定型心绞痛、心力衰竭和总心脏事件发生率均显著低于BMS组,依次为7.6%比35.5%,(P<0.01)、10.6%比35.5%(P<0.01)、0%比8.1%(P<0.05)和12.1%比46.8%(P<0.01);而急性心肌梗死和死亡发生率方面无显著差异(P>0.05)。结论:与BMS比较,SES显著降低了AMI患者直接PCI术后的支架再狭窄率和心脏事件的发生,而在再闭塞率方面无显著差异。

Objective：The clinical impact of Sirolimus-eluting stents （SES） implantation for patients with acute myocardial in farction （AMI） is currently unknown, this study was to investigate the difference of stent restenosis , stent reocclusion and clinical outcome between primary SES and conventional bare mental stents（BMS） in patients with AMI. Methods： Four hundred and eighty nine consecutive AMI patients treated by primary percutaneous coronary intervention （PCI） were divided into SES group （225 cases） or BMS group （273 cases）. The difference of the incidence of main adverse cardiac events （MACE）, including death, re-infarction, or repeat revascularization,stent restenosis rate,and stent reocclusion rate were assessed. The cardiac events of stent restenosis and stent reocclusion in AMI patients treated with SES compared to bare stents. Results： At mean 8 months follow-up, treatment with SES significantly reduced the incidence of MACE（5.6% v.s 12.6% ,P〈0.01） ,the restenosis rate in stent（1.3% vs. 8.9%,P〈0.01））and the restenosis rate in segment（2.7% vs. 9.5% ,P〈0.01）. The incidence and the clinical outcome of acute stent reocclusion rate were similar in both the SES and the BMS （P〉0.05）, which manifested as acute myocardial infarction needed target vessel revascularization. In terms of the cardiac events in patients with stent restenosis and chronic total occlusion, ischemic target vessel revascularization（7.6 % vs. 35.5 %, P〈0.01）, unstable angina（ 10.6% vs. 35.5%,P〈0.01）, heart failure（ 0% vs. 8.1%,P〈0.05） and total cardiacevents（12.1% vs. 46.8%,P〈0.01） were significantly decreased in SESs group than BMS group , but acute myocardial infarction and death were not different（P〉0.05）. Conclusion：Compared to conventional BMS, the SES is effective in reducing the incidence of stent restenosis rate and cardiac events and is not associated with an increased risk of stent reocclusion in patients with AMI referred for primary angioplasty.