支架类型对急性ST段抬高型心肌梗死患者住院病死率的影响  

Effects of drug-eluting and bare-metal stents on in-hospital case-fatality rate of patients with acute myocardial infarction

作　　者：于泓[1] 陈惠卿[1] 高文强[1] 陈吉[1] 戴洁[1] 马文林[1] 丁可可[1] 王凡[1] 刘孙夷[1] 刘一楠[1] 肖莉彬[1] 刘忠柳[1] 

机构地区：[1]同济大学附属同济医院心内科,上海200065

出　　处：《上海医学》2013年第9期775-779,共5页Shanghai Medical Journal

基　　金：上海市浦江人才计划项目资助(09PJ1410400)

摘　　要：目的了解在急诊经皮冠状动脉介入治疗(PCI)中使用药物涂层支架或裸支架对急性ST段抬高型心肌梗死(STEMI)患者住院病死率的影响。方法收集整理1991年1月-2011年12月在同济大学附属同济医院心内科病房连续住院的2 314例STEMI患者的临床资料,统计其年龄、性别,合并心源性休克、高血压、糖尿病、血脂异常、肾损害的情况,溶栓和使用血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β受体阻滞剂(BB)、阿司匹林、氯吡格雷、盐酸噻氯匹定等药物的基线情况,以及行PCI、植入支架类型、住院病死率等临床资料。结果植入药物涂层支架患者中合并糖尿病、血脂异常的构成比均显著高于植入裸支架者(P值均<0.05),心内科重症监护病房护理的构成比显著高于植入裸支架者(P<0.05),使用BB、他汀类药物、氯吡格雷的构成比均显著高于植入裸支架者(P值分别<0.05、0.001),使用盐酸噻氯匹定的构成比显著低于植入裸支架者(P<0.001)。开通急诊PCI绿色通道后STEMI患者的住院病死率为13.2%(222/1 687),显著低于开通急诊PCI通道前的20.6%(129/627,P<0.01)。874例行支架植入术的患者中,植入药物涂层支架患者的病死率为3.9%(23/597),与植入裸支架患者的4.3%(12/277)的差异无统计学意义(P>0.05)。对急诊PCI术中植入支架的874例STEMI患者行多元Logistic回归分析发现,心源性休克(P=0.000)、年龄(P=0.01)、累及下壁或前壁(P=0.005)、累及冠状动脉的数目(P=0.000,尤其是累及左主干)、血脂异常(P=0.001),以及未使用ACEI/ARB(P=0.000)、阿司匹林(P=0.000)、氯吡格雷(P=0.000)和他汀类药物(P=0.000)是其住院病死率的独立危险因素,而与支架类型不相关(P>0.05)。结论急诊PCI能明显降低STEMI患者的住院病死率,不同类型支架对住院病死率无明显影响。Objective To explore the effects of drug-eluting stent （DES） or bare-metal stent （BMS） implantation in primary percutaneous coronary intervention （PCI） on in-hospital case-fatality rate of patients with ST-segment elevation myocardial infarction （STEMI）. Methods From January 1991 to December 2011, a total of 2 314 patients were admitted for STEMI at Shanghai Tongji Hospital. Baseline data including age, gender, and comorbidities （cardiogenic shock, hypertension, diabetes mellitus, dyslipidemia and renal insufficiency） were collected. Meanwhile, the information of drugs including angiotensin-converting enzyme inhibitors （ACEI）, angiotensin receptor antagonists （ARB）, ^-blockers （BB）, aspirin, clopidogrel and ticlid, and the information of thrombolysis, POl, stent type, in-hospital case-fatality rate were also collected. Results The constituent ratios of diabetes mellitus and dyslipidemia, coronary care unit （CCU） nursing, taking BB, statins and clopidogrel in DES group were significantly higher than that in BMS group （P〈0.05, or 0.01）. But the ratio of taking ticlid in DESgroup was significantly lower than that in BMS group （P〈0. 001 ）. With the establishment of emergency-PCl, the in-hospital case-fatality rate of patients with STEMI decreased from 20.6% （129/627） to 13.2% （222/1 687, P〈0.01）. Stents were implanted in 874 patients with STEMI during emergency POI. There was no significant difference in case-fatality between the patients undergoing DES and BMS （3.9% [23/597] vs. 4.3% [12/277], χ^2= 3. 12, P〉 0.05）. The multivariate Logistic regression showed that cardiogenic shock （P= 0. 000）, age （P = 0.01 ）, disease involving the inferior wall or anterior （P = 0. 005）, the number of coronary arteries involved （ P = 0. 000, particularly involving the left main coronary artery）, dyslipidemia （ P = 0. 001 ）, as well as unused ACEI/ARB （P= 0. 000）, aspirin （P = 0. 000）, clopidogrel （P = 0. 000） and statins （P = 0. 000）

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入治疗 药物涂层支架 裸支架 住院病死率 

分 类 号：R542.22[医药卫生—心血管疾病]