西罗莫司与依维莫司药物洗脱支架治疗非ST段抬高型急性冠状动脉综合征的疗效比较  

Comparison of Sirolimus and Everolimus Drug-eluting Stents for Treating the Patients With Non ST-elevation Acute Coronary Syndrome

作　　者：张娜娜[1] 魏广和[2] 张韶辉[2] 刘立新[2] 王建军[2] 杨国良[2] 高荣华 戴雯[2] 

机构地区：[1]济宁医学院,山东省济宁市272000 [2]济宁医学院附属医院

出　　处：《中国循环杂志》2016年第5期437-441,共5页Chinese Circulation Journal

基　　金：济宁市医药卫生科技项目(2013jnnk22)

摘　　要：目的：比较西罗莫司药物洗脱支架（SES）和依维莫司药物洗脱支架（EES）用于治疗非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者的疗效和安全性。方法：对2013-09至2014-09在我院诊断为NSTE-ACS的400例患者,根据置入的支架不同分成SES组220例,EES组180例。进行随访1.5年的前瞻性研究分析,比较两组主要心血管不良事件（MACE）发生率。对每例患者进行GRACE评分,并依据分值再进行分层：低危层〈109分,中危层109~140分,高危层〉140分。采用Kaplan-Meier法计算无MACE生存率曲线,用Long-rank检验分析。绘制受试者工作特征（ROC）曲线,验证GRACE评分对患者1.5年终点事件的发生率的预测价值。结果：355例患者完成随访,随访率89%,随访时间（16.7±5.7）个月,其中SES组205例,EES组150例;SES组1.5年MACE发生率16.1%,EES组1.5年MACE发生率18.0%,组间差异无统计学意义（P〉0.05）。根据GRACE评分危险分层分析：高危层SES组累积MACE发生率高于EES组,差异有统计学意义（48.00%vs 16.00%,P〈0.05）;低危层（9.11%vs 12.86%）、中危层（14.49%vs 28.00%）,两组间差异无统计学意义（P均〉0.05）。GRACE评分ROC曲线分析结果：曲线下面积=0.762,95%可信区间：1.026~1.050,P〈0.001。结论：对于GRACE评分高危层的NSTE-ACS患者置入EES比置入SES更加获益。GRACE评分预测NSTE-ACS远期预后有良好的预测价值。Objective： To compare the efficacy and safety of sirolimus-eluting stent（SES） and everolimus-eluting stent（EES） for treating the patients with non-ST segment elevation acute coronary syndrome（NSTE-ACS）. Methods： A total of 400 NSTE-ACS patients treated in Jining Medical College Hospital from 2013-09 to 2014-09 were studied. According to different stents, the patients were divided into 2 groups： SES group, n=220 and EES group, n=180. A prospective follow-up study was conducted for 1.5 years to compare the incidence rate of major adverse cardiovascular events（MACE）. The patients were further stratified by GRACE scores as Low risk group（score〈109）, Medium risk group（score 109-140） and High risk group（score〉140）. MACE free survival was studied by Kaplan-Meier curve and analyzed by Long-rank test, predictive value of GRACE for 1.5 year MACE incidence rate was examined.Results： There were 355/400（89%） patients completed（16.7 ± 5.7） months of follow-up study including 205 in SES group and 150 in EES group. MACE occurrence rates were similar between SES group and EES group（16.10% vs 18.0%）, P〉0.05. By GRACE score stratification, MACE rates in High risk SES group were higher than High risk EES group（48.00% vs 16.00%）, P〈0.05; while they were similar between Medium risk groups（14.49% vs 28.00%） and Low risk groups（9.11% vs 12.86%）, all P〉0.05. ROC curve indicated that the predictive value of GRACE score for 1.5 year MACE incidence was for AUC=0.762, 95% CI（1.026-1.050）, P〈0.001.Conclusion： Implanting of EES would be more beneficial for NSTE-ACS patients with high GRACE risk; GRACE score has the better predictive value for their long-term prognosis.

关 键 词：急性冠状动脉综合征 药物洗脱支架 西罗莫司 依维莫司 

分 类 号：R54[医药卫生—心血管疾病]