高海,颜红兵,朱小玲,李南,艾辉,李世英,杨铎,王健,孙晓东,慈维萍

• 1: 首都医科大学附属北京安贞医院心肺血管疾病抢救中心
• 2:首都医科大学附属北京安贞医院心肺血管疾病抢救中心
• 3:首都医科大学附属北京安贞医院心肺血管疾病抢救中心
• 4:首都医科大学附属北京安贞医院心肺血管疾病抢救中心

摘要(Abstract)：

目的评估在ST段抬高心肌梗死(STEMI)患者应用国产西罗莫司洗脱支架的安全性和有效性。方法将1年内连续入选STEMI的患者随机分为国产西罗莫司洗脱(火鸟)支架组或金属裸支架(BMS)组。对所有患者连续临床随访6个月,术后6个月常规行冠状动脉造影。试验主要终点是术后6个月靶病变区晚期管腔丢失(LLL),次要终点包括支架内血栓发生率和主要心脏不良事件(MACE)。结果试验前6个月共入选85例患者。国产西罗莫司(火鸟)支架组42例,平均年龄58·1岁。BMS组43例,平均年龄59·8岁。两组6个月血管造影随访率分别为47·6%和44·2%。6个月随访结果显示,国产西罗莫司(火鸟)支架组死亡率、靶血管重建率(TVR)和MACE分别为2·4%,0%和2·4%,BMS组相应为4·7%,31·6%和25·6%(P<0·05)。BMS组有1例发生支架内亚急性血栓。定量冠状动脉造影结果显示,国产西罗莫司(火鸟)支架组支架内平均LLL为0·18mm,BMS组为0·72mm。结论与BMS比较,国产西罗莫司(火鸟)支架能够有效降低STEMI患者6个月死亡率、TVR和MACE发生率,其急性或亚急性支架血栓发生率低。

关键词(KeyWords)： 心肌梗死;支架;西罗莫司

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 高海,颜红兵,朱小玲,李南,艾辉,李世英,杨铎,王健,孙晓东,慈维萍

参考文献(References)：

• [1]Keeley EC,Boura JA,Grines CL.Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction:a quantitiative reviewof23randomised trials.Lancet,2003,261:13-20.
• [2]颜红兵,朱小玲,柯元南,等.常规开展直接冠状动脉介入治疗的5年总结.中华急诊医学杂志,2005,14:64-67.
• [3]Moses JW,Leon MB,Popma JJ,et al.Sirolimus-elutingstents verus standard stentsin patients withstenosisin a native coronary arteries.NEngl J Med,2003,349:1315-1323.
• [4]Stone GW,Ellis SG,Cox DA,et al.Apolymer-based,paclitaxel-eluting stent in patients with coronary artery disease.NEngl J Med,2004;350:221-231.
• [5]Lemos PA,Saia F,Hofman SH,et al.Short and long termclinical benefit of sirolimus-eluting stents compared to conventional bare stents for patients with acute myocardiol infarction.J Am Coll Cardiol,2004,43:704-708.
• [6]Hofma SH,van der Giessen WJ,van Dalen BM,et al.Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation.Eur Heart J,2006,27:166-170.
• [7]Babinska A,Markell MS,Salifu MO,et al.Enhancement of human platelet aggregation and secretion induced by rapamycin.Nephrol Dial Transplant,1998,13:3153-3159.
• [8]Steffel J,Latini RA,Akhmedov A,et al.Rapamycin,but not FK-506,increases endothelial tissue factor expression:implications for drug-eluting stent design.Circulation,2005,112:2002-2011.
• [9]Guagliumi G,Farb A,Musumeci G,et al.Imagesin cardiovascular medicine.Sirolimus-eluting stent implantedin human coronary artery for16months:pathological findings.Circulation,2003,107:1340-1341.
• [10]Nebeker JR,Virmani R,Bennet CL,et al.Hypersensitivity cases associated with drug-eluting coronary stents:a review of available cases from the Research on Adverse Drug Events and Reports(RADAR)project.J AmColl Cardiol,2006,47:175-181.
• [11]Hofma SH,Ong AT,Aoki J,et al.One year clinical followup of paclitaxel elutingstentsfor acute myocardial infarction compared with sirolimus eluting stents.Heart,2005,91:1176-1180.
• [12]Weber F,Schneider H,Schwarz C,et al.Sirolimus-eluting stents for percutaneous coronary intervention in acute myocardial infarction lesson froma case-controlled comparison of bard metal versus drug-eluting stents in thrombus-laden lesions.Z Kardiol,2004,93:938-943.
• [13]Cheneau E,Rhs SW,Kuchulakanti PK,et al.Impact of sirolimus-eluting stents on outcomes of patients treated for acute myocardial infarction by primary angioplasty.Catheter Cardiovasc Interv,2005,65:469-472.
• [14]Saia F,Lemos PA,Lee CH,et al.Sirolimus-eluting stent implantation in ST-elevation acute myocardial infarction:a clinical and angiographic study.Circulation,2003,108:1927-1929.
• [15]Margheri M,Giglioli C,Comeglio M,et al.Early outcome after paclitaxel-eluting stents in patients with acute and subacute myocardial infarction.Aclinical study.Ita Heart J,2004,5:536-540.
• [16]Valgimigli M,Percoco G,Malagutti P,et al.Tirofiban and sirolimus-eluting stents vs abciximab and bare-metal stents for acute myocardial infarction:a randomized trial.JAMA,2005,293:2109-2117.