A randomized trial comparing myocardial salvage achieved by coronary stenting versus balloon angioplasty in patients with acute myocardial infarction considered ineligible for reperfusion therapy
A randomized trial comparing myocardial salvage achieved by coronary stenting versus balloon angioplasty in patients with acute myocardial infarction considered ineligible for reperfusion therapy
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DOI：
10.1016/j.jacc.2003.07.054
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发表时间：
2004-03-03
影响因子：
24
通讯作者：
Schömig, A
中科院分区：
文献类型：
--
作者：
Kastrati, A;Mehilli, J;Schömig, A
目的比较经皮冠状动脉介入治疗(PCI)和球囊血管成形术(PTCA)对不适合溶栓治疗的急性心肌梗死(AMI)患者的心肌挽救作用。背景：目前有相当比例的急性心肌梗死患者被认为不适合溶栓治疗，因此通常不推荐再通治疗。目前尚不清楚这些患者是否从经皮冠状动脉介入治疗中受益。方法支架或经皮冠状动脉腔内成形术(PTCA)治疗急性心肌梗死不能溶栓患者(STOPAMI-3)，这是一项随机开放研究，包括611名不能溶栓的急性心肌梗死患者(心电图ST段无抬高、症状出现后12小时出现延迟，以及溶栓禁忌症)。患者被随机分配到接受冠状动脉支架植入术(n=305)和经皮冠状动脉腔内成形术(n=306)。核素心肌挽救指数(初始心肌灌注缺损区再灌注挽救的比例)是本研究的主要终点。在接受支架植入的患者中，挽救指数的中位数为0.54(第25和75个百分位数，0.29和0.87)，而接受PTCA的患者的中位数为0.50(第25和75个百分位数，0.26和0.82)(p=0.20)。接受支架植入组和PTCA组的6个月死亡率分别为8.2%和9.2%(p=0.69)。结论目前常规指南认为不适合溶栓治疗的急性心肌梗死患者可从直接经皮冠状动脉介入治疗中受益。在这些患者中，当支架置入术的策略与PTCA策略进行比较时，其益处似乎是可比较的。(C)2004年，由美国心脏病学会基金会提供。
OBJECTIVES We assessed myocardial salvage achieved by reperfusion with percutaneous coronary interventions (PCI) and compared stenting with balloon angioplasty (PTCA) in patients with acute myocardial infarction (AMI) ineligible for thrombolysis.BACKGROUND A substantial proportion of patients with AMI are currently considered ineligible for thrombolysis, and reperfusion treatment is frequently not recommended for them. It is not known whether these patients benefit from PCI.METHODS The Stent or PTCA for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Ineligible for Thrombolysis (STOPAMI-3) trial, a randomized, open-label study, included 611 patients with AMI who were ineligible for thrombolysis (lack of ST-segment elevation on the electrocardiogram, late presentation >12 h after symptom onset, and contraindications to thrombolysis). Patients were randomly assigned to receive either coronary artery stenting (n = 305) or PTCA (n = 306). Scintigraphic myocardial salvage index (proportion of the initial myocardial perfusion defect that was salvaged by reperfusion) was the primary end point of the study.RESULTS A considerable myocardial salvage was achieved with both stenting and PTCA. In patients assigned to receive stenting, the median size of the salvage index was 0.54 (25th and 75th percentiles, 0.29 and 0.87), as compared with a median of 0.50 (25th and 75th percentiles, 0.26 and 0.82) in the group assigned to receive PTCA (p = 0.20). Mortality at six months was 8.2% in the group of patients assigned to receive stenting and 9.2% in the group of patients assigned to receive PTCA (p = 0.69).CONCLUSIONS Patients with AMI who are currently considered ineligible for thrombolysis by conventional guidelines may greatly benefit from primary PCI. The benefit seems to be comparable when a strategy of stenting is compared with a strategy of PTCA in these patients. (C) 2004 by the American College of Cardiology Foundation.