刘兆平,张岩,霍勇,代表中国急性心肌梗死救治项目一期课题组

• 1:北京大学第一医院心内科

摘要(Abstract)：

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%CI1.51～2.11,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%CI2.01～3.02,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%CI0.71～1.87,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。

关键词(KeyWords)： 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

Abstract:

Keywords:

基金项目(Foundation): 赛诺菲-安万特和雅培公司对本研究课题的资助

作者(Author): 刘兆平,张岩,霍勇,代表中国急性心肌梗死救治项目一期课题组

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