王云飞,李小明,薛淞,华琦,李康,郝恒剑,刘志,李博宇,胡少东,许骥,夏经刚,孔强,桑城,王姗,李静

• 1:首都医科大学北京附属宣武医院心脏科

摘要(Abstract)：

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。

关键词(KeyWords)： 急性ST段抬高心肌梗死;药物洗脱支架;预后;进口;国产

Abstract:

Keywords:

基金项目(Foundation): 首都医科大学基础临床合作课题(13JL34);; 首都医学发展基金(2009-1054)

作者(Author): 王云飞,李小明,薛淞,华琦,李康,郝恒剑,刘志,李博宇,胡少东,许骥,夏经刚,孔强,桑城,王姗,李静

参考文献(References)：

• [1]Hong YJ,Jeong MH,Ahn Y,et al.The effi cacy and safety of drugeluting stent in Patients with acute myocardial infarction:results from KoreaAcute Myocardial Infarction(KAMIR).Int J Cardiol2013,163:1-4.
• [2]Urban P,Abizaid A,Banning A,et al.Stent thrombosis and bleeding complications after imPlantation of sirolimus-eluting coronary stents in an unselected worldwide PoPulation:a rePort from the e-SELECT(Multi-Center Post-Market Surveillance)registry.J Am Coll Cardiol2011,57:1445-1454.
• [3]Wallace EL,Abdel-Latif A,Charnigo R,et al.Meta-analysis of long-term outcomes for drug-eluting stents versus bare-metal stents in primary percutaneous coronary interventions for ST-segmen elevation myocardial infarction.Am J Cardial,2012,109:932-940.
• [4]Kalesan B,Pilgrim T,Heinimann K,et al.Comparison of drugeluting stents with bare metal stents in patients with ST-segmen elevation myocardial infarction.Eur heart J,2012,33:977-987.
• [5]Assali A,Vaduganathan M,Vaknin-Assa H,et al.Comparison of late(3-year)registry data outcomes using bare metal versus drugeluting stents for treating ST-segment elevation acute myocardia infarctions.Am J Cardial,2012,109:1563-1568.
• [6]Palmerini T,Biondi-Zoccai G,Della Riva D,et al.Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segmen elevation myocardial infarction:Evidence From a ComPrehensive Network Meta-Analysis.J Am Coll Cardiol,2013,62:496-504.
• [7]Task Force on the management of ST-segment elevation acute myocardial infarction of the EuroPean Society of Cardiology(ESC)ESC Guidelines for the management of acute myocardial infarction in Patients Presenting with ST-segment elevation.Eur Heart J,201233:2569-2619.
• [8]中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2010,38:675-690.
• [9]张晗,杨艳敏,朱俊,等.不同入院心率水平与ST段抬高型心肌梗死患者预后的关系.中华心血管病杂志,2012,40:18-24.
• [10]Camenzind E,Wijns W,Mauri L,et al.Stent thrombosis and major clinical events at 3 years after zotarolimus-eluting or sirolimuseluting coronary stent implantation:a randomized,multicentre,open-label,controlled trial.Lancet,2012,380:1396-1405.
• [11]Tada T,Byrne RA,Cassese S,et al.Comparative efficacy of 2zotarolimus-eluting stent generations:resolute versus endeavor stents in Patients with coronary artery disease.Am Heart J,2013,165:80-86.
• [12]Han Y,Jing Q,Li Y,et al.Sustained clinical safety and effi cacy of a biodegradable-Polymer coated sirolimus-eluting stent in"realworld"Practice:three-year outcomes of the CREATE(Multi-Center Registry of EXCEL Biodegradable Polymer Drug Eluting Stents)study.Catheter Cardiovasc Interv,2012,79:211-216.
• [13]King LA,Kastrati A,Byrne RA.Treatment of coronary drug-eluting stent restenosis:a journey back to the future.Expert Rev Med Devices,2013,10:423-427.
• [14]杜润,张瑞岩,朱政斌,等.国产与进口西罗莫司洗脱支架置人后血管内超声随访的对比.中华心血管病杂志,2010,38:121-125.
• [15]田峰,陈韵岱,陈练,等.光学相干断层成像评价不同类型药物洗脱支架置人术后的内膜覆盖.中华心血管病杂志,2011,39:204-207.
• [16]高展,杨跃进,陈纪林,等.生物可降解与非可降解雷帕霉素药物洗脱支架一年临床及七个月造影随访.中华心血管病杂志,2008,36:1074-1077.
• [17]于淼,周玉杰,阎赢,等.进口与国产雷帕霉素洗脱支架一年临床疗效比较.中国介入心脏病学杂志,2011,19:95-99.
• [18]高海,张宏,叶明,等.老年急性ST段抬高心肌梗死患者应用国产雷帕霉素药物洗脱支架5年临床随访.中华老年心脑血管病杂志,2012,14:590-592.
• [19]李强,王乐丰,杨新春,等.可降解涂层与不可降解涂层雷帕霉素洗脱支架在急性心肌梗死直接经皮冠状动脉介入治疗中的疗效比较.中华心血管病杂志,2012,38:886-890.
• [20]Holme I,Aastveit AH,Hammar N,et al.Uric acid and risk of myocardial infarction,stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study(AMORIS).J Intern Med,2009,266:558-570.
• [21]Berton G,Cordiano R,Cavuto F,et al.Predictors of ten-year eventfree survival in patients with acute myocardial infarction(from the Adria,Bassano,Conegliano,and Padova Hospitals[ABC]study on myocardial infarction).Am J Cardiol,2012,109:966-975.