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目的比较急性ST段抬高型心肌梗死患者使用无聚合物紫杉醇微孔载药支架(垠艺支架)与永久聚合物雷帕霉素洗脱支架(EXCEL支架)的临床安全性和有效性。方法选取收住院的急性ST段抬高型心肌梗死患者103例,根据植入的支架类型不同分为垠艺组67例(植入支架80枚)和EXCEL组36例(植入支架44枚)。观察2组基本临床情况、冠状动脉病变特征、基本介入技术指标及围术期情况,术后对患者进行1年随访,观察有无复发心绞痛、支架内血栓形成及重要心脏不良事件发生情况。结果 2组患者即刻手术成功率均为100.0%。2组患者罪犯血管、植入支架的长度、直径和平均植入支架数目、EF值、血栓抽吸比例、心源性休克的比例、术后ST段回落情况等方面比较差异均无统计学意义(P>0.05)。1年临床随访显示垠艺组非心源性死亡1例(1.5%);支架内再狭窄1例(1.5%),建议行CABG;复发心绞痛4例(6.0%)。EXCEL组复发心绞痛1例,组间差异均无明显统计学意义(P>0.05)。结论急性ST段抬高型心肌梗死的患者应用无聚合物紫杉醇微孔载药支架与永久聚合物雷帕霉素洗脱支架近、中期的安全性和有效性是相当的。
Objective To compare the clinical safety and efficacy of using polymer-free paclitaxel-loaded microporous drug-eluting stent and permanent polymer rapamycin-eluting stent (EXCEL stent) in patients with acute ST-segment elevation myocardial infarction. Methods A total of 103 patients with acute ST-elevation myocardial infarction admitted to hospital were enrolled in this study. According to the types of stents implanted, there were 67 cases (80 implanted stents) and 36 EXCEL stents (44 implanted stents) . The basic clinical situation, the characteristics of coronary lesions, the basic interventional techniques and perioperative conditions were observed in two groups. Patients were followed up for one year after operation to observe the presence or absence of recurrent angina pectoris, stent thrombosis and important cardiac events. Results Immediate success rate of the two groups of patients were 100.0%. There were no significant differences in the criminals’ blood vessels, the length and diameter of implanted scaffolds, the mean number of implanted stents, the EF value, the proportion of thrombus aspiration, the proportion of cardiogenic shock and postoperative ST segment depression (P> 0.05). One year clinical follow-up showed that non-cardiac death occurred in 1 case (1.5%) in Eunyi group; 1 case (1.5%) was in-stent restenosis. CABG was recommended; 4 patients (6.0%) had recurrent angina pectoris. One case of recurrent angina pectoris in EXCEL group showed no significant difference between the two groups (P> 0.05). Conclusions The safety and efficacy of the polymer-free paclitaxel-loaded microporous drug-eluting stent with the permanent polymer rapamycin-eluting stent in the near and the mid-term are comparable in patients with acute ST-segment elevation myocardial infarction.