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目的探讨雷帕霉素洗脱支架(SES)在STEMI患者PCI中的疗效及安全性。方法2002年10月至2004年12月112例住院患者,男了4例,女38例,平均年龄(63．5±15．2)岁,根据病史、心电图、血清标记物(CK-MB、CTn-I)确诊为ST段抬高性心肌梗死(STEMI),于发病后40-650 min,接受急诊PCI处理梗死相关血管(IRA)并植入裸支架(BMS)或SES,分组对比观察患者术中情况,记录术后主要心脏事件(MACE):心脏性死亡、心绞痛复发、再梗死、靶病变血运重建率(TVR)。结果112例STEMI患者,其中62例植入BMS,50例植入SES,两组患者中PCI即刻IRA开通率(TIMI血流III级),差异无统计学意义(62／66比47／50,P>0．05),术中均无1例死亡,术后随访期MACE发生率BMS组显著高于SES组(11／66比3／50,P<0．01),其中BMS组心脏性死亡率略高于SES组,但差异无统计学意义(3／66比2／50),心绞痛复发率BMS组高于SES组,差异有统计学意义(8／66比1／50, P<0．01),TVR(PCI／CABG),BMS组显著高于SES组(6／66比1／50,P<0．01)。结论STEMI患者应用SES安全有效,即刻靶血管血运重建率与BMS无明显差异,随访期间,MACE发生率显著低于植入BMS的患者,MACE的减少主要与SES减少心绞痛复发、降低靶血管重建率有关,两者间恶性心脏事件的发生率相似。
Objective To investigate the efficacy and safety of rapamycin eluting stent (SES) in patients with STEMI. Methods From October 2002 to December 2004, 112 inpatients including 4 males and 38 females with a mean age of (63.5 ± 15.2) years were enrolled in this study. According to their medical history, electrocardiogram, serum markers (CK-MB, CTn-I) was diagnosed as ST-segment elevation myocardial infarction (STEMI). The infarct-related vessels (IRSs) were implanted in emergency PCI at 40-650 min after implantation and were implanted into BMS or SES. Intraoperative records of major cardiac events (MACE): cardiac death, recurrence of angina, reinfarction, target lesion revascularization rate (TVR). Results Among 112 STEMI patients, 62 were implanted with BMS and 50 were implanted with SES. There was no significant difference in PCI rate (TIMI grade III) between the two groups (62/66 vs 47/50, P> 0.05). No one died during operation. The incidence of MACE at follow-up was significantly higher in BMS group than that in SES group (11/66 vs 3/50, P <0.01) The mortality rate was slightly higher than that of SES group, but the difference was not statistically significant (3/66 to 2/50). The recurrence rate of angina pectoris was higher in BMS group than in SES group (8/66 vs 1/50, P < 0.01), TVR (PCI / CABG), BMS group was significantly higher than the SES group (6/66 than 1/50, P <0.01). Conclusions SES is safe and effective in patients with STEMI. The rate of immediate revascularization of target vessel is not significantly different from that of BMS. During follow-up, the incidence of MACE is significantly lower than that of patients with BMS. The decrease of MACE mainly decreases the recurrence of angina with SES and decreases the target revascularization Rate, the incidence of malignant cardiac events between the two similar.