不同药物支架在急性心肌梗死临床治疗中的应用:中国人群比较

Clinical application of varying drug-eluting stents for the treatment of acute myocardial infarction among Chinese population

背景:西罗莫司药物洗脱支架和紫杉醇药物洗脱支架是目前临床中常用的两种药物支架,西罗莫司药物洗脱支架在急性心肌梗死患者中应用的安全性及有效性已得到证实,但是两者的对比研究较少。目的:观察进口西罗莫司药物洗脱支架和紫杉醇药物洗脱支架在急性ST段抬高心肌梗死患者急诊经皮冠状动脉介入治疗中应用的安全性和远期疗效。方法:选择唐山工人医院心内科收治的因ST段抬高急性心肌梗死行急诊经皮冠状动脉介入治疗且接受西罗莫司药物洗脱支架和紫杉醇药物洗脱支架资料完整的患者354例,男259例,女95例;根据置入支架类型将所有入选病例分为西罗莫司药物洗脱支架组(n=213)和紫杉醇药物洗脱支架组(n=141)。比较2组随访1年时主要心脏事件的发生率。结果与结论:随访1年时的西罗莫司药物洗脱支架组与紫杉醇药物洗脱支架组在再发心肌梗死(1.5%,1.5%)和心脏性死亡(2.5%,3.0%)的发生率方面两组之间无显著性差异。造影随访结果显示:两组支架再狭窄率(5.0%,4.5%)无显著性差异,管腔内径丢失西罗莫司药物洗脱支架组为(0.19±0.34)mm,紫杉醇药物洗脱支架组(0.19±0.37)mm,两组无显著性差异。随访1年时的心脏事件发生率两组无显著性差异(8.9%,9.1%,P>0.05)。提示西罗莫司药物洗脱支架和紫杉醇药物洗脱支架在ST段抬高心肌梗死急诊经皮冠状动脉介入治疗中应用安全有效,疗效相近。

BACKGROUND： Sirolimus- and Paclitaxel-eluting stents are commonly used for clinical application. Sirolimus-eluting stent have been proved safely and effectively to treat acute myocardial infarction. However, the comparison between those two eluting stents has been less reported yet. OBJECTIVE： To compare the security and long-term efficacy between Sirolimus- and Paclitaxel-eluting stents to the treatment of ST-segment acute myocardial infarction via percutaneous transluminal coronary intervention. METHODS： A total of 354 patients with ST-segment acute myocardial infarction, including 259 males and 95 females, were administrated with Sirolimus- and Paclitaxel-eluting stents. All cases were randomly divided into Sirolimus-eluting stent group （n=213） and Paclitaxel-eluting stent group （n=141）. Major adverse cardiovascular events were compared between the two groups during 1-year following up. RESULTS AND CONCLUSION： One-year following up indicated that there was no significant difference in recurrent myocardial infarction （1.5% vs. 1.5%） and cardiac death （2.5% vs. 3.0%） between the two groups. Radiography showed that there was no significant difference in restenosis rate （5.0% vs. 4.5%） between the two groups. Inner diameter lose was （0.19±0.34） mm in the Sirolimus-eluting stent group and （0.19±0.37） mm in the Paclitaxel-eluting stent group, and there was no significant difference. Additionally, there was also no significant difference in major adverse cardiovascular events between the two groups （8.9% vs. 9.1%, P〉 0.05）, suggesting that both Sirolimus- and Paclitaxel-eluting stents were safe and effective to the treatment of ST-segment acute myocardial infarction via percutaneous transluminal coronary intervention.