药物洗脱支架血栓形成并发急性ST段抬高型心肌梗死的预后研究

Prognosis of patients with acute ST-elevation myocardial infarction due to drug-eluting stent thrombosis

目的分析药物洗脱支架(DES)血栓形成引起急性ST段抬高型心肌梗死(STEMI)的临床和直接冠状动脉介入治疗(PCI)特征及预后。方法31例因DES血栓形成引起STEMI(ST组)和93例由原发冠状动脉病变所致STEMI患者(对照组)接受直接PCI治疗。记录各例临床和PCI特征及1年随访结果。研究主要终点为院内及1年累积主要心脏不良事件(MACE),包括死亡、非致命性再梗死及靶血管再次血运重建(TVR)。结果与对照组比较,ST组年龄较大(69.9±11.4岁比63.7±13.6岁,P=0.01),糖尿病(41.9%比22.6%,P=0.04)和既往心肌梗死史(29.0%比11.8%,P=0.02)明显增多;直接PCI后冠状动脉TIMI 3级血流显著降低(45.2%比92.5%,P<0.001)。ST组院内死亡率(16.1%比3.2%,P=0.01)和MACE发生率(25.8%比7.5%,P=0.007)显著增高,术后1年总生存率及无MACE生存率显著降低(分别为77.4%比92.5%,P=0.016;59.4%比85.1%,P=0.001)。结论DES血栓形成引起STEMI患者即使接受直接PCI治疗,其院内死亡及MACE发生率仍显著高于由原发冠状动脉病变所致的心肌梗死患者。

Objective To evaluate clinical and procedural characteristics and outcomes of patients with ST-elevation myocardial infarction （STEMI） caused by drug-eluting stent （DES） thrombosis undergoing primary percutaneous coronary intervention （PCI）. Methods From October 2004 to June 2007, 31 patients with STEMI due to definite DES thrombosis who received primary PCI were retrospectively studied （ST group）. Baseline clinical, angiographic, PCI procedural features and 1-year outcomes were recorded. Another consecutive 93 patients with STEMI due to de novo coronary thrombosis were served as control group. The primary endpoint was cumulative rate of major adverse cardiac events （MACE）, including death, reoccurrence of myocardial infarction and target vessel revascularization （TVR）, during hospitalization and at 1-year follow-up. Results Compared with the control group, patients in ST group were older （69. 9 ±11.4 y and 63.7 ±13.6 y, P =0. 01 ） and higher comorbidity rates of diabetes （41.9% and 22. 6% , P = 0. 04） and previous history of myocardial infarction （ 29. 0% and 11.8 % , P = 0.02 ）. The occurrence of TIMI 3 flow immediately after primary PCI was reduced （45.2% and 92. 5%, P 〈 0. 001 ）, and in-hospital mortality （ 16. 1% and 3.2%, P =0. 01 ） and MACE rate （25.8% and 7.5%, P =0. 007） were higher in ST group than in the control group. At 1-year follow-up, death- and MACE-free survival rates were lower in ST group compared with control group （77.4% and 92.5% , P =0. 016; 59.4% and 85.1%, P = 0. 001, respectively）. Conclusion Patients with STEMI due to DES thrombosis had worse clinical prognosis with higher in-hospital mortality and MACE rate than those due to de novo coronary thrombosis despite treated with primary PCI.