急性心肌梗死置入药物洗脱支架与裸金属支架的安全性及即时效应比较

背景：药物洗脱支架越来越多应用于冠状动脉狭窄患者，效果良好。但急诊应用于急性心肌梗死患者的研究报道较少。目的：对比观察Firebird支架(雷帕霉素洗脱支架)与普通金属裸支架在急性ST段抬高型心肌梗死急诊经皮腔内冠状动脉介入治疗中应用的安全性和临床疗效。设计、时间及地点：回顾性分析，病例来自2006-01/2008-09洛阳150医院心内科。对象：选择洛阳150医院心内科收治的ST段抬高型急性心肌梗死行直接经皮腔内冠状动脉介入治疗患者94例，男71例，女23例，年龄47~76岁。方法：94例患者随机分为2组，Firebird支架组：均在靶病变置入Firebird支架1或2枚；普通支架组：在靶病变置入金属裸支架1或2枚。主要观察指标：两组患者的安全性、临床疗效及随访情况。结果：①94例患者介入治疗均获得成功。Firebird支架组52例，共置入68枚药物涂层支架；普通支架组42例，共置入56枚普通支架。两组平均置入支架个数、手术成功率、支架置入并发症发生率、置入前置入后平均狭窄程度及操作时间等差异均无显著性意义(P > 0.05)；两组选用的支架内径相比，Firebird支架明显偏小(P < 0.01)；两组支架长度相比，Firebird支架显著偏长(P < 0.05)。②住院期间观察两组患者心肌酶峰值，TnI峰值，血管开通后2 h ST段下降幅度，左室功能差异均无显著性意义(P > 0.05)。两组靶血管重建Firebird支架组1例，普通支架组2例，差异亦无显著性意义(P > 0.05)。两组各有2例患者死亡，住院期间心脏事件发生率差异无显著性意义(P > 0.05)。Firebird支架组和普通支架组平均住院时间差异无显著性意义[(11.3±4.2)，(12.4±4.6)d，P > 0.05]。③出院后随访1~10个月，平均(6.5±2.4)个月，两组患者无心源性死亡、再梗死。普通支架组心绞痛发生率35.5%较Firebird支架组21.0%显著增高(P < 0.01)。Firebird支架组无心脏事件生存率95%；显著高于普通支架组78%(P < 0.01)。结论：雷帕霉素药物洗脱支架与普通支架一样在ST段抬高型急性心肌梗死急诊经皮腔内冠状动脉介入中是安全有效的。

Safty and instant effects of of drug-eluting stent versus bare metal stent implantation following emergency percutaneous coronary intervention in patients with acute myocardial infarction

BACKGROUND: Drug-eluting stent has been widely used to treat coronary artery stenosis, with promising effect. However, little is know about the application in acute myocardial infarction in emergency.OBJECTIVE: To compare the safety and efficacy of Firebird drug-eluting stents and bare metal stents implantation after the emergency percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (STEAMI).DESIGN, TIME AND SETTING: Retrospective analysis. The cases were selected from Department of Cardiology, Luoyang 150 Hospital between January 2006 and September 2008.PARTICIPANTS: A total of 94 STEAMI patients undergoing direct PCI in Department of Cardiology, Luoyang 150 Hospital were selected, including 71 males, 23 females aged 47-76 years. METHODS: The 94 cases were randomly divided into two groups, Firebird group (n=52) undergoing 1 or 2 Firebird stents at target lesion, and BMS group (n=42) implanted with 1 or 2 bare metal stents at target lesion. MAIN OUTCOME MEASURES: The safety, clinical efficacy and the follow-up information were observed.RESULTS: Of the 94 cases, all PCI operations were successful with 68 Firebird drug-eluting stents in Firebird group and 56 BMS in BMS group. There were no significant differences in implanted stents quantity, operation achievement ratio, PCI complication incidence rate, mean stenosis degree of pre or post operation and PCI duration (P > 0.05). While the average inner diameter of Firebird drug-eluting stents was smaller than BMS group (P < 0 01), and the length of Firebird drug-eluting stents was longer than BMS group (P < 0.05). There were no significant differences with myocardial creatase peak value, TnI peak value, ST-segment descent 2 hours after blood vessel unobstructed and left ventricular function between Firebird group and BMS group (P > 0.05). There was 1 case with the target vessel reconstruction in Firebird group and 2 cases in BMS group (P > 0.05). There were 2 cases death in both group, and the heart event rate between two groups without significant difference (P > 0.05). The length of stays of two groups was similar [(11.3±4.2) days, (12.4±4.6) days, P > 0.05]. During the (6.5±2.4) month (range 1 to 10 months) follow-up, the angina incidence rate of the Firebird group was lower than the BMS group (21.0%, 35 5%, P < 0.01), and without heart event rate of the Firebird group was higher than the BMS group (95%, 78%, P < 0.01). No cardiac death or re-infarction took place in both groups. CONCLUSION: Implantation of Firebird drug-eluting stent after the emergency PCI is as safe and effective as the conventional bare metal stent in patients with STEAMI.