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目的探讨与稳定性心绞痛患者相比,急性冠状动脉综合征患者植入药物洗脱支架后的远期疗效是否同样显著优于金属裸支架。方法自2000年1月-2007年12月期间,3771例冠状动脉性心脏病患者接受择期经皮冠状动脉内支架植入术并完成1年的临床随访。根据介入治疗的指征分为急性冠状动脉综合征组和稳定性心绞痛组,将每组进一步分为药物洗脱支架亚组与金属裸支架亚组。研究终点为死亡、Q波心肌梗死、靶血管血运重建以及确定的支架内血栓形成。结果急性冠状动脉综合征组和稳定性心绞痛组中,药物洗脱支架亚组与金属裸支架亚组相比,随访1年的病死率、Q波心肌梗死发生率的差异均无统计学意义(P值均>0.05)。在稳定性心绞痛组中,药物洗脱支架亚组的靶血管血运重建率(5.6%)较金属裸支架亚组(11.4%)显著降低(P<0.01);而在急性冠状动脉综合征组中,药物洗脱支架亚组的靶血管血运重建率(8.0%)与金属裸支架亚组(7.2%)的差异无统计学意义(P>0.05)。两组中支架内血栓均非常少见,且亚组间发生率的差异无统计学意义(P值均>0.05)。结论择期冠状动脉介入治疗选择药物洗脱支架可显著降低稳定性心绞痛患者远期靶血管血运重建率,但急性冠状动脉综合征患者未能获得相似的疗效。该临床结果可能源于易损粥样斑块是急性冠状动脉综合征的主要病因。
Objective To investigate whether the long-term efficacy of stent implantation in patients with acute coronary syndrome is significantly better than that of bare metal stent in patients with stable angina. Methods From January 2000 to December 2007, 3771 patients with coronary heart disease underwent elective percutaneous coronary stenting and completed a one-year clinical follow-up. According to the indications of interventional therapy, the patients were divided into acute coronary syndrome group and stable angina group. Each group was further divided into drug-eluting stent group and metal-bare stent group. The study’s endpoint was death, Q-wave myocardial infarction, target revascularization, and established stent thrombosis. Results There was no significant difference in the incidence of Q-wave myocardial infarction between the 1-year follow-up and Q-wave myocardial infarction in the patients with acute coronary syndrome and stable angina. P value> 0.05). In the stable angina group, the target vessel revascularization rate (5.6%) in the drug-eluting stent group was significantly lower than that in the bare metal stent group (11.4%) (P <0.01), while in the acute coronary syndrome group There was no significant difference in the target vessel revascularization rate (8.0%) between the drug-eluting stent group and the bare metal stent group (7.2%) (P> 0.05). Stent thrombosis was very rare in both groups, and there was no significant difference in the incidence of subgroups between the two groups (P> 0.05). Conclusions Elective coronary stent implantation can significantly reduce the long-term target vessel revascularization rate in patients with stable angina, but patients with acute coronary syndromes can not achieve similar efficacy. This clinical result may result from the vulnerability of atherosclerotic plaque is the main cause of acute coronary syndrome.