在急性心肌梗塞中经皮肤冠状动脉干预后,支架血栓的发生频率和预测因素
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
概括
对于ST段升高心肌梗塞的初级皮肤冠状动脉干预后的支架血栓形成是常见的,与药物排泄或裸金属支架发生类似情况. 优化抗血和抗血小板治疗可能会降低这种风险.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 血栓形成研究研究
背景情况:
- 对于ST段升高心肌梗塞 (STEMI) 的初级穿皮冠状动脉干预 (PCI) 后的支架血栓形成风险存在持续的担忧.
- 了解影响支架血栓形成的因素对于改善PCI后患者的治疗结果至关重要.
研究的目的:
- 评估在接受STEMI初级PCI的患者中,支架血栓的发生率和预测因素.
- 为了比较不同抗血栓策略和支架类型之间的支架血栓形成率.
主要方法:
- 在HORIZONS-AMI试验中,3602名STEMI患者随机接受初级PCI治疗,接受氨酸加上糖蛋白IIb/IIIa抑制剂 (GPI) 或比瓦利鲁丁单疗法.
- 在两年内分析了支架血栓事件,比较药物排泄支架 (DES) 与裸金属支架 (BMS) 以及比瓦利鲁丁与肝素/GPI治疗.
主要成果:
- 在2年内,4.4%的患者发生整体支架血栓形成,DES和BMS的发病率相似 (4.4%).
- 比瓦利鲁丁单一治疗显示,与肝素/GPI (4.6%) 相比,两年内支架血栓发生率相似 (4.3%).
- 急性支架血栓形成是比瓦利鲁丁 (1.4%) 与肝素/GPI (0.3%) 较高,但非常晚的事件是比瓦利鲁丁 (2.8%与4.4%) 较低.
结论:
- 支架血栓是STEMI初级PCI后2年内发生的显著事件,在支架类型和主要抗血栓治疗方案中发生的频率相似.
- 早期服用抗血素治疗和强效抗血小板药物可能是减少STEMI患者支架血栓形成的关键.
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