裸金属支架和药物洗脱支架在急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗中的应用和结局分析:来自中国急性心肌梗死救治项目一期的结果  

Selection of bare metal stent and drug eluting stent in acute ST-segment elevation myocardial infarction primary percutaneous coronary intervention and the impact on in-hospital outcome:result from CSCAP-1

作　　者：刘兆平[1] 张岩[1] 霍勇[1] 中国急性心肌梗死救治项目一期课题组 LIU Zhao-ping;ZHANG Yan;HUO Yong;on Behalf CSCAP group(Department of Cardiology,Peking University First Hospital,Beijing 100034,China;不详)

机构地区：[1]北京大学第一医院心内科,北京100034 [2]不详

出　　处：《中国介入心脏病学杂志》2020年第4期187-191,共5页Chinese Journal of Interventional Cardiology

基　　金：赛诺菲-安万特和雅培公司对本研究课题的资助

摘　　要：目的分析在直接经皮冠状动脉介入治疗(PCI)中影响裸金属支架(BMS)或药物洗脱支架(DES)选择的主要因素,并进一步分析接受BMS和DES的患者住院期间临床结局是否存在差异。方法入选中国急性心肌梗死救治项目第一阶段来自53家医院的3387例直接PCI术中支架置入患者,收集其临床资料。以DES或BMS使用为因变量,分析影响支架类型选择的因素。进一步分析应用DES和BMS患者院内临床结局是否存在差异。结果logistic多因素回归分析显示,前壁心肌梗死(OR 1.79,95%CI 1.51~2.11,P<0.001)、合并糖尿病(OR 1.28,95%CI 1.05~1.56,P=0.015)、球囊预处理(OR 2.46,95%CI 2.01~3.02,P<0.001)、支架后扩张(OR 1.22,95%CI 1.04~1.44,P=0.018)与支架选择相关。一级复合终点DES组与BMS组发生率分别是3.4%和2.7%,差异无统计学意义(OR 1.28,95%CI 0.79~2.05,P=0.312)。在经过年龄、性别、Killip心功能分级Ⅳ级、是否前壁心肌梗死、高血压病史、糖尿病病史、肾功能衰竭病史、心肌梗死病史、手术时机、支架种类多因素调整后两组发生率差异无统计学意义(OR 1.15,95%CI 0.71~1.87,P=0.575)。单独对院内死亡进行分析,也未发现支架选择与院内死亡产生的相关性(OR 0.97,95%CI 0.51~1.82,P=0.919)。结论DES时代,在进行ST段抬高型心肌梗死行直接PCI的过程中,患者具体的临床情况影响着介入医师对DES或BMS的选择。选择DES或BMS对患者住院期间的主要临床结局影响并无显著差异。Objective Acute ST-segment elevation myocardial infarction(STEMI)is an important threat to human being,and primary percutaneous coronary intervention(PCI)can improve the prognosis of STEMI patients effectively.This study was focused on the main factors those may affect the selection of bare metal stent(BMS)or drug eluting stent(DES)during primary PCI in real world.The in-hospital outcome was also analyzed comparing the BMS and DES group.Methods Clinic data of 3387 patients from 53 hospitals was collected who enrolled in China STEMI Care Project Phase 1.The clinic factors those may affect the choice of BMS or DES are analyzed.Further analysis was performed to demonstrate if in-hospital outcome was different between DES and BMS group.Results Patients with anterior wall myocardial infarction or diabetes history were more likely to undergo DES implantation even after adjusted by multifactor(anterior wall infarction vs.the others,OR 1.79,95%CI 1.51–2.11,P<0.001,diabetes history yes vs.no,OR 1.28,95%CI 1.05–1.56,P=0.015).In procedure related factors,predilation with balloon(adjusted by multifactor,yes vs.no,OR 2.46,95%CI 2.01–3.02,P<0.001)and postdilation(adjusted by multifactor,yes vs.no,OR 1.22,95%CI 1.04–1.44,P=0.018)were associated with DES implantation.Composite end point of death,nonfatal myocardial infarction,revascularization and non-fatal stroke or in-hospital death were not related with type of stent.Conclusions In DES era,the choice between DES and BMS was determined by individual clinical setting during STEMI primary PCI,and this study didn’t find any difference of inhospital outcome between DES and BMS group.

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 药物洗脱支架 裸金属支架 

分 类 号：R541.4[医药卫生—心血管疾病]