进口与国产药物洗脱支架治疗急性ST段抬高心肌梗死的预后分析

目的 进口和国产药物洗脱支架（DES）治疗急性ST段抬高心肌梗死（STEMI）的住院期间与远期预后比较.方法 连续入选2009年1月至2010年8月的197例确诊急性STEMI并行冠状动脉介入治疗的患者,按照支架的类型分为国产DES组和进口DES组,比较两组住院期间和长期心脑血管事件发生率.结果 国产DES组共113例（57.4％）,进口DES组84例（42.6％）,两组住院期间全因死亡率（2.7％比4.8％,P=0.515）、严重心力衰竭发生率（2.7％比0,P=0.053）、恶性心律失常发生率（10.6％比3.6％,P=0.098）差异均无统计学意义;两组患者随访中位数41个月,随访期内两组的无事件生存率分别为91.5％和90.9％ （P=0.885）.多因素分析显示,高龄（HR=1.872,95％ CI：1.008～2.118,P=0.023）、高血压史（HR=6.018,95％ CI：1.307～21.716,P=0.021）、脑血管病史（HR=4.995,95％ CI：1.536～16.242,P=0.008）、心功能Killip分级（HR=3.947,95％ CI：1.809～8.612,P=0.001）、高尿酸血症（HR=1.006,95％ CI：1.003～1.010,P＜0.001）是患者远期发生全因死亡、非致死性心肌梗死、再次血运重建、严重心力衰竭、脑血管病的独立危险因素.结论 急性STEMI患者,应用国产与进口DES住院期间及远期预后差异无统计学意义.

Comparison of clinical prognosis in ST-segment elevation myocardial infarction patients between domestic versus imported drug-eluting stents

Objective To compare the clinical prognosis between patients using domestic DES versus imported DES with ST-segment elevation myocardial infarction. Methods Consecutive 197 patients presenting with ST segment elevation myocardial infarction （STEMI） from January 2009 to August 2010 in Xuanwu Hospital were enrolled in this study. All Patients received drug-eluting stent （DES） implantation and were divided into two groups according to the usage of stents （the domestic stents group and the imported stents group）. Long-term outcomes were compared between the two groups. Results There were 113 （57.4%） patients undergoing domestic DES implantation and the other 84 patients received imported DES. In-hospital mortality of the domestic stent group and the imported stent group were 2.7% vs. 4.8% （P=0.515）, severe heart failure were 2.7% vs. 0 （P=0.053） and severe arrhythmia were 10.6% vs. 3.6% （P=0.098）. During a 4-year follow up, the event-free survival rate was 91.5% in the domestic DES group and 90.9% in the foreign DES group （P=0.885）. In multivariable, analyses, age,hypertension, cerebrovascular disease, cardiac function class, uric acid level were independent determinants for long-term events. Conelusions The domestic drug-eluting stents and imported drug-eluting stents may yield comparable long term outcomes in the treatment of patients with STEMI.