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目的:评价ST段抬高心肌梗死患者靶血管超长病变部位串联置入西罗莫司洗脱支架的安全性和有效性。方法:2007-01至2007-12间连续入选行急诊经皮冠状动脉介入治疗(PCI)的ST段抬高心肌梗死患者297例,资料均前瞻性录入数据库。筛选靶血管超长病变部位串联置入2枚或2枚以上西罗莫司洗脱支架的患者进行分析。终点分析指标:住院期间和随访6个月时的主要不良心脏事件(包括心因性死亡、非致死性心肌梗死和靶病变重建)发生率。结果:研究期间内发现31例患者共计31处长病变置入2枚或以上支架。每位患者平均病变长度(47.2±10.3)mm,平均置入2.1枚支架,平均支架长度(53.2±10.5)mm,均获得手术成功。所有患者均完成临床随访,74.2%的患者完成6个月的冠状动脉造影随访。主要不良心脏事件发生率为8.7%,主要归因于靶病变重建,没有发生心因性死亡和致死性心肌梗死。结论:直接PCI过程中串联置入西罗莫司支架治疗靶血管长病变未产生不良后果,临床效果良好。其长期的安全性和有效性有待大规模的临床试验进一步证实。
OBJECTIVE: To evaluate the safety and efficacy of sirolimus-eluting stent placed in tandem with long-term lesions of target vessels in patients with ST-segment elevation myocardial infarction. Methods: A total of 297 consecutive ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention (PCI) between January 2007 and December 2007 were prospectively enrolled in the database. Screening for long-term target lesions of the lesion in series with two or more than two sirolimus-eluting stent patients were analyzed. End point analysis: Incidence of major adverse cardiac events (including cardiac death, non-fatal myocardial infarction, and target lesion reconstruction) during hospitalization and at 6 months of follow-up. RESULTS: A total of 31 long lesions were found in 31 patients with 2 or more stents in the study period. Each patient had an average lesion length of 47.2 ± 10.3 mm with an average of 2.1 stents and an average stent length of 53.2 ± 10.5 mm, all of whom achieved successful surgery. All patients completed clinical follow-up, and 74.2% of patients completed 6-month follow-up of coronary angiography. The incidence of major adverse cardiac events was 8.7%, mainly attributable to the reconstruction of the target lesion and no cause of death from cardiac and fatal myocardial infarction. Conclusion: Long-term lesions of target vessels in direct PCI have no adverse effect on stenting of sirolimus in direct PCI. The clinical effect is good. Its long-term safety and effectiveness to be confirmed by large-scale clinical trials.