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目的探讨雷帕霉素药物洗脱支架(Cypher)在急性ST段抬高心肌梗死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2004年12月间的急性ST段抬高心肌梗死患者168例,于发病12h内行急诊PCI治疗,于梗死相关血管的靶病变置入Cypher支架。记录1个月和6个月随访终点时的主要心脏不良事件(包括死亡、再发心肌梗死、靶血管再成形等)发生率、支架内血栓发生率、支架内再狭窄发生率。结果168例患者急诊PCI治疗均获得成功。168支梗死相关血管的171处罪犯病变共置入175枚Cypher支架,未发生与介入治疗有关的并发症。1个月随访终点时死亡3例(死亡率1.8%);支架内亚急性血栓1例;主要心脏不良事件发生率2.4%。6个月随访终点时死亡4例(死亡率2.4%);主要心脏不良事件发生率4.2%;支架内血栓发生率1.2%;支架内再狭窄发生率1.8%。结论药物洗脱支架(Cypher)在急性ST段抬高心肌梗死急诊PCI中应用与普通支架一样有较强的安全性和有效性,并可以明显降低再狭窄率。
Objective To investigate the safety and efficacy of rapamycin-eluting stent (Cypher) in the treatment of patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI). Methods A total of 168 patients with acute ST-segment elevation myocardial infarction between November 2002 and December 2004 were enrolled in this study. Emergency PCI was performed within 12 hours of onset and Cypher stent was placed in the target lesion of infarct-related blood vessels. The incidence of major cardiac adverse events (including death, recurrent myocardial infarction, target vessel reshaping, etc.) at 1-month and 6-month follow-up were recorded. The incidence of stent thrombosis and the incidence of in-stent restenosis were recorded. Results 168 cases of emergency PCI were successful. A total of 175 Cypher stents were placed in 171 offenders in 168 infarcted vessels without complications associated with intervention. Three deaths occurred at the end of follow-up at 1 month (mortality, 1.8%); subacute thrombosis occurred in 1 case; and the incidence of major adverse cardiac events was 2.4%. Four patients died at the 6-month follow-up endpoint (mortality 2.4%); the incidence of major cardiac adverse events was 4.2%; the rate of stent thrombosis was 1.2%; and the rate of stent restenosis was 1.8%. Conclusion The application of Cypher in emergency PCI of ST-segment elevation myocardial infarction has the same safety and effectiveness as that of conventional stent, and can significantly reduce the rate of restenosis.