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目的了解在急诊经皮冠状动脉介入治疗(PCI)中使用药物涂层支架或裸支架对急性ST段抬高型心肌梗死(STEMI)患者住院病死率的影响。方法收集整理1991年1月-2011年12月在同济大学附属同济医院心内科病房连续住院的2 314例STEMI患者的临床资料,统计其年龄、性别,合并心源性休克、高血压、糖尿病、血脂异常、肾损害的情况,溶栓和使用血管紧张素转换酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β受体阻滞剂(BB)、阿司匹林、氯吡格雷、盐酸噻氯匹定等药物的基线情况,以及行PCI、植入支架类型、住院病死率等临床资料。结果植入药物涂层支架患者中合并糖尿病、血脂异常的构成比均显著高于植入裸支架者(P值均<0.05),心内科重症监护病房护理的构成比显著高于植入裸支架者(P<0.05),使用BB、他汀类药物、氯吡格雷的构成比均显著高于植入裸支架者(P值分别<0.05、0.001),使用盐酸噻氯匹定的构成比显著低于植入裸支架者(P<0.001)。开通急诊PCI绿色通道后STEMI患者的住院病死率为13.2%(222/1 687),显著低于开通急诊PCI通道前的20.6%(129/627,P<0.01)。874例行支架植入术的患者中,植入药物涂层支架患者的病死率为3.9%(23/597),与植入裸支架患者的4.3%(12/277)的差异无统计学意义(P>0.05)。对急诊PCI术中植入支架的874例STEMI患者行多元Logistic回归分析发现,心源性休克(P=0.000)、年龄(P=0.01)、累及下壁或前壁(P=0.005)、累及冠状动脉的数目(P=0.000,尤其是累及左主干)、血脂异常(P=0.001),以及未使用ACEI/ARB(P=0.000)、阿司匹林(P=0.000)、氯吡格雷(P=0.000)和他汀类药物(P=0.000)是其住院病死率的独立危险因素,而与支架类型不相关(P>0.05)。结论急诊PCI能明显降低STEMI患者的住院病死率,不同类型支架对住院病死率无明显影响。
Objective To investigate the effect of drug-eluting or bare-metal stents on in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) during emergency percutaneous coronary intervention (PCI). Methods The clinical data of 2 314 cases of STEMI hospitalized in the Department of Cardiology of Tongji Hospital of Tongji University from January 1991 to December 2011 were collected and analyzed. The clinical data of patients with STEMI including age, gender, cardiogenic shock, hypertension, diabetes, Dyslipidemia, renal damage, thrombolysis and the use of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta blockers (BBs), aspirin, clopidogrel, Ticlopidine hydrochloride and other drugs baseline conditions, and the line of PCI, stent type, hospital mortality and other clinical data. Results The proportions of diabetes mellitus and dyslipidemia in patients with drug-eluting stents were significantly higher than those in patients with bare stents (all P <0.05), and the proportions of nursing care in cardiological intensive care unit were significantly higher than those with bare stents (P < 0.05). The constituent ratios of BB, statins and clopidogrel were significantly higher than that of bare stent (P <0.05, 0.001 respectively). The constituent ratio of ticlopidine hydrochloride was significantly lower than that of bare stent (P <0.001). In-hospital mortality was 13.2% (222/1 687) in STEMI patients after emergency PCI, and was significantly lower than that of 20.6% (129/62 7, P <0.01) prior to emergency PCI. Among 874 patients who underwent stent implantation, the mortality rate was 3.9% (23/597) in patients with drug-eluting stents and 4.3% (12/277) in patients with bare stents (P> 0.05). Multivariate Logistic regression analysis of 874 STEMI patients with stents implanted in emergency PCI found that the incidence of cardiogenic shock (P = 0.000), age (P = 0.01), involving the inferior or anterior wall (P = 0.005) The number of coronary arteries (P = 0.000, especially with involvement of the left main), dyslipidemia (P = 0.001), and those without ACEI / ARB (P = 0.000), aspirin (P = 0.000), clopidogrel ) And statins (P = 0.000) were independent risk factors for in-hospital mortality, but not related to the type of stent (P> 0.05). Conclusions Emergency PCI can significantly reduce the in-hospital mortality rate in patients with STEMI. Different types of stents have no significant effect on in-hospital mortality.