Biodegradable and non-biodegradable drug-eluting stents and bare metal stents in acute myocardial infarction

doi:10.3969/j.issn.2095-4344.2014.34.007

Abstract

Abstract:

BACKGROUND: Large randomized controlled clinical trials have shown that drug-eluting stents has a lower restenosis rate compared with bare-metal stents, but the drug-eluting stents cannot reduce major cardiovascular events and death rates, and long-term follow-up of clinical registries show the drug-eluting stents even may increase late stent thrombosis events.

OBJECTIVE: To evaluate the incidence of stenosis and adverse reactions after treatment with biodegradable, non-biodegradable drug-eluting stents and bare-metal stents in patients after myocardial infarction.

METHODS: We retrospectively analyzed the clinical data of 236 cases of acute myocardial infarction, in which 79 cases were treated with biodegradable sirolimus-eluting stents, 83 cases treated with non-biodegradable sirolimus-eluting stents, and 74 cases treated with bare metal stents. Then, we compared late lumen loss and restenosis within 12 months after stent implantation and major adverse cardiac reactions within 24 months after stent implantation.

RESULTS AND CONCLUSION: After 12 months, the late lumen loss of the bare stent group was significantly higher than that of biodegradable and non-biodegradable sirolimus-eluting stent groups (P < 0.05), but the difference in stent restenosis rate (P > 0.05). After 24 months, there were no differences in death, cardiac death, recurrent myocardial infarction, target vessel revascularization, target lesion revascularization, major adverse cardiac events and stent thrombosis events among the three groups. These three kinds of stents need to be further studied in their long-term efficacy and safety as percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: myocardial infarction, angioplasty, coronary restenosis

CLC Number:

R318

Yang Zhen . Biodegradable and non-biodegradable drug-eluting stents and bare metal stents in acute myocardial infarction[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(34): 5449-5454.

Figures/Tables 3

2.1 参与者数量分析 236例患者均进入结果分析。 2.2 纳入临床病例资料分析共纳入236例急性心肌梗死患者临床资料，分为载药生物可降解膜被覆金属支架组(可降解药物涂层支架组)(n=79)、不可降解药物涂层支架组(n=83)、裸金属支架组(n=74)，3组在性别、年龄、基线资料、冠状动脉造影结果等方面差异无显著性意义(表1)。 2.3 各组患者术后情况评估 3组在冠状动脉支架置入成功率方面差异无显著性意义(表2)。可降解药物涂层支架组、不可降解药物涂层支架组及裸支架组分别有26例(22.8%)、22例(19.3%)和15例(20.3%)(P=0.494)患者因非梗死相关病变严重，在术后7-10 d再次接受冠状动脉支架置入。 2.4 支架置入后12个月冠状动脉造影随访(次要终点) 支架置入12个月后对可降解药物涂层支架组79例患者的43处靶病变和不可降解药物涂层支架组83例患者的47处，以及裸支架组74例患者的39处靶病变行冠状动脉造影，分别占患者总数的54.1%，56.6%和57.2%。3组间节段内晚期管腔丢失、再狭窄发生方面差异无显著性意义，但裸支架组支架内晚期官腔丢失还是要多于可降解药物涂层支架组(表3)。 2.5 住院期间和支架置入后24个月临床随访(主要终点) 3组患者全部完成24个月临床随访。住院期间和支架置入后24个月随访时3组患者在死亡、心因性死亡、再发心肌梗死、靶血管血运重建、靶病变血运重建及主要不良心脏事件发生率方面差异无显著性意义。支架内血栓形成事件3组间差异无显著性意义(表4)。 logistic多元回归分析显示，校正性别、年龄、糖尿病、高血压、吸烟、左心室射血分数、使用替罗非班因素后，支架类型(Cypher Select)与24个月的主要不良心脏事件(OR=0.87，95%可信区间0.63-1.26，P=0.542)无显著关系，支架类型与支架内血栓形成(OR=1.17，95%可信区间0.68-2.04，P=0.576)的发生亦无显著关系。"

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