急性心筋梗塞における皮膚経冠動脈介入後のステント栓塞の頻度と予測要因
George D Dangas1, Adriano Caixeta, Roxana Mehran
1Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA. george.dangas@mssm.edu
Circulation
|April 13, 2011
まとめ
STセグメントの上昇による心筋梗塞に対する一次性皮膚経冠動脈介入後のステント栓塞は一般的であり,薬剤エリューテーションまたは裸金属ステントでも同様に発生します. アンチトロンビンおよび抗血小板治療の最適化は,このリスクを軽減することができます.
科学分野:
- 心臓病学 心臓病学
- 介入性心臓病学 介入性心臓病学
- トロンボシス研究研究
背景:
- STセグメント上昇心筋梗塞 (STEMI) による一次皮経冠動脈干渉 (PCI) の後のステント血栓形成のリスクに関する懸念が持続しています.
- ステントの血栓形成に影響を与える要因を理解することは,PCI後の患者のアウトカムを改善するために重要です.
研究 の 目的:
- STEMIのためのプライマリPCIを受ける患者におけるステント栓塞の発生率と予測要因を評価する.
- 異なる抗血栓戦略とステントタイプ間のステント栓塞率を比較する.
主な方法:
- HORIZONS-AMI試験では,3602人のSTEMI患者をランダムに選択し,ヘパリンとグリコプロテインIIb/IIIa阻害剤 (GPI) またはビヴァリルジン単独療法によるプライマリPCIを受けた.
- ステントトロンボシス事件は,2年以内に分析され,薬物排出ステント (DES) と裸金属ステント (BMS) とビヴァリルジン対ヘパリン/GPI治療を比較しました.
主要な成果:
- 2年以内に全ステント栓塞は患者の4.4%で発生し,DESとBMSの割合も同様 (4.4%) であった.
- ビバリルジン単独療法では,ヘパリン/GPI (4.6%) と比較して,2年後のステント血栓形成率 (4.3%) が類似した.
- 急性ステント血栓症はビヴァリルジン (1.4%) とヘパリン/GPI (0.3%) により高かったが,非常に遅いイベントはビヴァリルジン (2.8% vs 4.4%) により低かった.
結論:
- ステント血栓症は,STEMIのプライマリPCI後2年以内に発生する重要なイベントであり,ステントタイプと主要な抗血栓療法において同様の頻度で発生します.
- アンチトロンビン療法と強力な抗血小板剤の早期投与は,STEMI患者におけるステント血栓症の軽減に重要な役割を果たす可能性があります.
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