Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group.
Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group.
复制标题
冠状动脉成形术联合或不联合支架植入治疗急性心肌梗死。
DOI：
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发表时间：
2000
影响因子：
158.5
通讯作者：
M. Morice
中科院分区：
文献类型：
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作者：
C. Grines;D. Cox;G. Stone;E. García;L. Mattos;A. Giambartolomei;B. Brodie;O. Madonna;M. Eijgelshoven;A. Lansky;W. O’Neill;M. Morice
背景
冠状动脉支架植入术是治疗急性心肌梗死的常用方法。然而，很少有研究将支架植入与单纯的直接血管成形术进行比较。
方法
我们设计了一项多中心研究，以比较直接血管成形术和伴随肝素涂层的Palmaz-Schatz支架植入的血管成形术。对急性心肌梗死患者行急诊插管和血管成形术。那些血管适合支架植入的患者被随机分成两组，分别接受支架成形术(452例)和单纯血管成形术(448例)。
结果
支架术后平均(+/-SD)最小管腔直径大于单独血管成形术后(2.56+/-0.44 mm vs.2.12+/-0.45 mm，P<；0.001)，尽管被分配到支架置入组的患者较少有3级血流(根据心肌梗死溶栓试验的分类)(89.4%，而血管成形组为92.7%；P=0.10)。6个月后，支架组比血管成形组出现心绞痛(11.3%比16.9%，P=0.02)或因缺血而需要靶血管重建术(7.7%比17.0%，P<；0.001)的患者更少。此外，由于缺血导致的死亡、再梗塞、致残中风或靶血管再血管化的合并主要终点，支架组患者比血管成形组患者少(12.6%比20.1%，P<；0.01)。合并终点的减少完全是由于靶血管血运重建需求的减少。支架组和血管成形组6个月死亡率分别为4.2%和2.7%(P=0.27)。血管造影随访6.5月显示支架组再狭窄发生率低于血管成形组(20.3%vs.33.5%，P<；0.001)。
结论
在急性心肌梗死患者中，常规的支架植入比单纯的直接冠状动脉成形术有更多的临床益处。
BACKGROUND
Coronary-stent implantation is frequently performed for treatment of acute myocardial infarction. However, few studies have compared stent implantation with primary angioplasty alone.
METHODS
We designed a multicenter study to compare primary angioplasty with angioplasty accompanied by implantation of a heparin-coated Palmaz-Schatz stent. Patients with acute myocardial infarction underwent emergency catheterization and angioplasty. Those with vessels suitable for stenting were randomly assigned to undergo angioplasty with stenting (452 patients) or angioplasty alone (448 patients).
RESULTS
The mean (+/-SD) minimal luminal diameter was larger after stenting than after angioplasty alone (2.56+/-0.44 mm vs. 2.12+/-0.45 mm, P<0.001), although fewer patients assigned to stenting had grade 3 blood flow (according to the classification of the Thrombolysis in Myocardial Infarction trial) (89.4 percent, vs. 92.7 percent in the angioplasty group; P=0.10). After six months, fewer patients in the stent group than in the angioplasty group had angina (11.3 percent vs. 16.9 percent, P=0.02) or needed target-vessel revascularization because of ischemia (7.7 percent vs. 17.0 percent, P<0.001). In addition, the combined primary end point of death, reinfarction, disabling stroke, or target-vessel revascularization because of ischemia occurred in fewer patients in the stent group than in the angioplasty group (12.6 percent vs. 20.1 percent, P<0.01). The decrease in the combined end point was due entirely to the decreased need for target-vessel revascularization. The six-month mortality rates were 4.2 percent in the stent group and 2.7 percent in the angioplasty group (P=0.27). Angiographic follow-up at 6.5 months demonstrated a lower incidence of restenosis in the stent group than in the angioplasty group (20.3 percent vs. 33.5 percent, P<0.001).
CONCLUSIONS
In patients with acute myocardial infarction, routine implantation of a stent has clinical benefits beyond those of primary coronary angioplasty alone.