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目的:比较急性心肌梗死(AMI)患者应用西罗莫司洗脱支架(SES)与裸金属支架(BMS)植入术后支架内再狭窄发生率、再闭塞发生率以及临床预后的差异。方法:498例行直接冠心病介入治疗(PCI)的AMI患者分为西罗莫司洗脱支架组(225例)和裸金属支架组(273例),比较两组主要不良心脏事件(包括再次心肌梗死、缺血性靶血管重建和死亡)发生率及再狭窄率和再闭塞率的差异,分析支架再狭窄和闭塞患者所出现的心脏事件发生有无不同。结果:平均随访时间8个月,SES组的主要不良心脏事件(MACE)发生率、支架内再狭窄率以及节段内再狭窄率均显著低于BMS组,依次为5.6%比12.6%(P<0.01)、1.3%比8.9%(P<0.01)和2.7%比9.5%(P<0.01);再发心肌梗死和心脏性死亡的发生率两组无显著差异。两组急性支架闭塞率及其导致的临床预后无显著差异(P>0.05),主要表现为再次急性心肌梗死,并需要再次靶血管重建。而支架再狭窄和慢性闭塞患者所出现的心脏事件方面,SES组的缺血性靶血管重建、不稳定型心绞痛、心力衰竭和总心脏事件发生率均显著低于BMS组,依次为7.6%比35.5%,(P<0.01)、10.6%比35.5%(P<0.01)、0%比8.1%(P<0.05)和12.1%比46.8%(P<0.01);而急性心肌梗死和死亡发生率方面无显著差异(P>0.05)。结论:与BMS比较,SES显著降低了AMI患者直接PCI术后的支架再狭窄率和心脏事件的发生,而在再闭塞率方面无显著差异。
OBJECTIVE: To compare the rate of stent restenosis, the incidence of recanalization and the clinical prognosis of acute myocardial infarction (AMI) patients with sirolimus-eluting stent (SES) and bare metal stent (BMS) implantation. Methods: A total of 498 AMI patients undergoing direct PCI were divided into two groups: the sirolimus-eluting stent group (225 cases) and the bare metal stent group (273 cases). The adverse cardiac events Myocardial infarction, ischemic target vessel reconstruction and death) and restenosis rate and reocclusion rate differences, analysis of stent restenosis and occlusion occurred in patients with cardiac events have any difference. Results: The average incidence of adverse cardiac events (MACE), in-stent restenosis and intra-segment restenosis in the SES group were significantly lower than those in the BMS group at an average follow-up of 8 months (5.6% vs. 12.6%, P <0.01), 1.3% vs 8.9% (P <0.01) and 2.7% vs 9.5% (P <0.01). There was no significant difference in the incidence of recurrent myocardial infarction and cardiac death between the two groups. Two groups of acute stent occlusion rate and the clinical prognosis caused by no significant difference (P> 0.05), mainly for the re-acute myocardial infarction, and the need for re-target vessel revascularization. However, the incidence of ischemic target vessel revascularization, unstable angina pectoris, heart failure and total cardiac events in SES patients was significantly lower than that in BMS patients in the restenosis and chronic occlusion patients, which were 7.6% 35.5% (P <0.01), 10.6% vs 35.5% (P <0.01), 0% vs 8.1% (P <0.05) and 12.1% vs 46.8% (P <0.01), while the incidence of acute myocardial infarction and death There was no significant difference (P> 0.05). CONCLUSIONS: Compared with BMS, SES significantly reduced the rate of stent restenosis and cardiac events after PCI in AMI patients, but no significant difference in reocclusion rates.