在ST段升高后的自然史和临床结果 心肌梗塞没有插入支架
Jason Nogic1, Benjamin Cailes2, Julian Yeoh2
1Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University and Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University and Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia.
The American journal of cardiology
|October 20, 2023
概括
对于没有严重阻塞的ST升高心肌梗塞 (STEMI) 患者,避免初始药物排泄支架 (DES) 插入会增加30天的死亡率. 建议在适当的情况下使用当前一代DES,以获得更好的结果.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 急性冠状动脉综合征是什么
背景情况:
- 在再注射后的ST段升高心肌梗塞 (STEMI) 管理可能是复杂的,当离散的严重狭窄性病变不明显时.
- 在这种情况下,在药物释放支架 (DES) 插入和初始医疗管理之间的最佳策略仍在争论中.
研究的目的:
- 评估没有初始支架治疗的STEMI患者的短期临床结果,与接受DES的患者相比.
- 确定没有初始支架的策略是否会影响死亡率和主要心脏不良事件.
主要方法:
- 预期在2014-2020年期间招募接受穿皮冠状动脉干预的STEMI患者.
- 排除患有支架内静止症,支架血栓症或住院死亡的患者.
- 基线特征和30天结局的比较,包括倾向匹配,在初始支架和没有支架的患者之间进行治疗.
主要成果:
- 一小部分 (3.3%) 的STEMI患者在没有初始支架的情况下接受治疗.
- 这些患者年龄较大,糖尿病的发病率较高,并且先前有过血管再循环.
- 与DES插入相比,没有支架与30天死亡率,心肌梗塞和主要心脏不良事件的显著增加有关.
结论:
- 在没有严重狭窄的STEMI患者中,不进行支架的初始策略与30天死亡率的增加有关.
- 当前一代DES插入应考虑在临床上适合STEMI患者时.
- 这项研究支持在精选的STEMI病例中使用DES以改善短期临床结果.
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