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目的探讨雷帕霉素药物洗脱支架在糖尿病急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和有效性。方法选择2002年11月至2005年10月间首都医科大学附属北京朝阳医院心脏中心收治的糖尿病急性STEMI患者106例,于发病12h内行急诊PCI治疗,置入雷帕霉素药物洗脱支架。记录术后1个月和12个月随访终点时的心血管事件发生率、支架内血栓发生率及支架内再狭窄发生率。结果105例患者急诊PCI治疗获得成功。106支梗塞相关血管(IRA)的110处罪犯病变处置入雷帕霉素药物洗脱支架134枚,未发生与介入治疗有关的并发症。1个月随访终点时死亡4例(3.77%),发生急性心肌梗死1例,心血管事件总发生率为4.72%;发生支架内血栓1例;血运重建1例。12个月随访终点时除1个月时死亡的4例外未再发生死亡病例,共发生心血管事件11例(10.38%),发生支架内血栓2例(1.89%),52例接受冠状动脉造影复查患者中发生支架内再狭窄6例(11.54%)。结论雷帕霉素药物洗脱支架在STEMI急诊PCI中应用有较高的安全性和有效性,并可以明显降低再狭窄率。
Objective To investigate the safety and efficacy of rapamycin-eluting stent in emergency percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods From November 2002 to October 2005, 106 acute STEMI patients admitted to Beijing Chaoyang Hospital Cardiac Center Affiliated to Capital Medical University were enrolled in this study. They were treated with PCI during 12 hours after the onset of PCI and placed in rapamycin-eluting stent. The incidence of cardiovascular events, the incidence of stent thrombosis and the incidence of in-stent restenosis at 1-month and 12-month follow-up were recorded. Results 105 patients were successfully treated with PCI. A total of 134 rapamycin-eluting stents were placed in 106 offenders in 106 infarct-related vessels (IRA) and no complications associated with interventional therapy occurred. At the end of follow-up at 1 month, 4 patients died (3.77%), 1 case had acute myocardial infarction, and the total incidence of cardiovascular events was 4.72%. One case of stent thrombosis occurred and 1 case of revascularization. There were no further deaths at 4 months at the end of the 12-month follow-up, except for 4 deaths at 1 month. Eleven cardiovascular events (10.38%) occurred, 2 cases (1.89%) had stent thrombosis, and 52 received coronary angiography Six patients (11.54%) had in-stent restenosis. Conclusion The application of rapamycin-eluting stent in the STEMI emergency PCI has high safety and effectiveness, and can significantly reduce the rate of restenosis.