Unrestricted Use of 2 New-Generation Drug-Eluting Stents in Patients With Acute Myocardial Infarction A Propensity Score-Matched Analysis
Unrestricted Use of 2 New-Generation Drug-Eluting Stents in Patients With Acute Myocardial Infarction A Propensity Score-Matched Analysis
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DOI：
10.1016/j.jcin.2012.05.009
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发表时间：
2012-09-01
影响因子：
11.3
通讯作者：
Park, Seung Jung
中科院分区：
文献类型：
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作者：
Chen, Kang-Yin;Rha, Seung-Woon;Park, Seung Jung
目的比较维罗莫司洗脱支架(EES)和ZES支架(ZES)在急性心肌梗死(AMI)患者中的应用。背景目前尚缺乏专门评价第二代药物洗脱支架(DES)在急性心肌梗死(AMI)治疗中的安全性和有效性的数据。应用倾向评分匹配来调整基线临床和血管造影特征的差异，总共产生2646名患者(1343名接受EES和1343名接受EES)。靶病变衰竭(TLF)被定义为心源性死亡、复发的非致命性心肌梗死或靶病变血运重建的复合体。结果倾向性评分匹配后，两组患者的基础临床和血管造影特征相似。倾向评分匹配的患者的临床结果表明，尽管复发的非致命性心肌梗死、住院和1年死亡率相似，但与ZES组相比，EES组患者的TLF率(6.5%vs.8.7%，p=0.029)和可能或确定的支架血栓形成(0.3%vs.1.6%，p<；0.001)显著降低。此外，EES组的靶病变血运重建率(1.2%vs.2.2%，p=0.051)低于EES组。结论在这项倾向匹配的比较中，EES在减少急性心肌梗死患者的TLF和支架血栓形成方面似乎优于ZES组。(J Am Coll心脏ol Intv 2012；5：936-45)(C)2012，美国心脏病学会基金会
Objectives This study sought to compare everolimus-eluting stents (EES) with zotarolimus-eluting stents (ZES) in patients with acute myocardial infarction (AMI).Background There is a paucity of data to exclusively evaluate the safety and efficacy of second-generation drug-eluting stents (DES) in the setting of AMI.Methods The present study enrolled 3,309 AMI patients treated with ZES (n = 1,608) or EES (n = 1,701) in a large-scale, prospective, multicenter registry-KAMIR (Korea Acute Myocardial Infarction Registry). Propensity score matching was applied to adjust for differences in baseline clinical and angiographic characteristics, producing a total of 2,646 patients (1,343 receiving ZES, and 1,343 receiving EES). Target lesion failure (TLF) was defined as the composite of cardiac death, recurrent nonfatal myocardial infarction, or target lesion revascularization. Major clinical outcomes at 1 year were compared between the 2 propensity score-matched groups.Results After propensity score matching, baseline clinical and angiographic characteristics were similar between the 2 groups. Clinical outcomes of the propensity score-matched patients showed that, despite similar incidences of recurrent nonfatal myocardial infarction and in-hospital and 1-year mortality, patients in the EES group had significantly lower rates of TLF (6.5% vs. 8.7%, p = 0.029) and probable or definite stent thrombosis (0.3% vs. 1.6%, p < 0.001), compared with those in the ZES group. Furthermore, there was a numerically lower rate of target lesion revascularization (1.2% vs. 2.2%, p = 0.051) in the EES group than in the ZES group.Conclusions In this propensity-matched comparison, EES seems to be superior to ZES in reducing TLF and stent thrombosis in patients with AMI. (J Am Coll Cardiol Intv 2012;5:936-45) (C) 2012 by the American College of Cardiology Foundation