Stents embebidos em sirolimus tem um melhor resultado tardio em relação à re-estenose e necessidade de reintervenção. Até o momento, porém, não se conhecia o comportamento destes stents em casos de infarto agudo do miocárdio (IAM). Em artigo publicado ontem na revista Circulation, pesquisadores holandeses avaliaram o uso de stents embebidos em sirolimus em casos de IAM com elevação eletrocardiográfica do segmento ST. Em uma análise de 96 casos, sendo os pacientes avaliados após 6 meses do implante do stent, os autores verificaram bons resultados, com patência e ausência de reestenose.
Circulation
Published online before print October 13, 2003, doi:10.1161/01.CIR.0000096053.87580.CD
(Circulation. 2003;108:1927.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
Sirolimus-Eluting Stent Implantation in ST-Elevation Acute Myocardial Infarction
A Clinical and Angiographic Study
Francesco Saia, MD; Pedro A. Lemos, MD; Chi-Hang Lee, MD; Chourmouzios A. Arampatzis, MD; Angela Hoye, MB ChB, MRCP; Muzaffer Degertekin, MD; Kengo Tanabe, MD; Georgios Sianos, MD, PhD; Pieter C. Smits, MD, PhD; Eugene McFadden, MB ChB, MRCPI; Sjoerd H. Hofma, MD; Willem J. van der Giessen, MD, PhD; Pim J. de Feyter, MD, PhD; Ron T. van Domburg, PhD; Patrick W. Serruys, MD, PhD
From the Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
Correspondence to Prof. Patrick W. Serruys, MD, PhD, Thoraxcenter, Bd-406, Dr. Molewaterplein 40,3015-GD Rotterdam, The Netherlands. E-mail p.w.j.c.serruys@erasmusmc.nl
Received June 30, 2003; revision received September 2, 2003; accepted September 2, 2003.
Background— Sirolimus-eluting stents (SES) have recently been proven to reduce restenosis and reintervention compared with bare stents. Safety and effectiveness of SES in acute myocardial infarction remain unknown.
Methods and Results— Since April 16, 2002, a policy of routine SES implantation has been instituted in our hospital, with no clinical or anatomic restrictions, as part of the RESEARCH (Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital) registry. During 6 months of enrollment, 96 patients with ST-elevation acute myocardial infarction underwent percutaneous recanalization and SES implantation; these patients comprise the study population. The incidence of major adverse cardiac events (death, nonfatal myocardial infarction, reintervention) was evaluated. Six-month angiographic follow-up was scheduled per protocol. At baseline, diabetes mellitus was present in 12.5% and multivessel disease in 46.9%. Primary angioplasty was performed in 89 patients (92.7%). Infarct location was anterior in 41 (42.7%) of the cases, and 12 patients (12.5%) had cardiogenic shock. Postprocedural TIMI-3 flow was achieved in 93.3% of the cases. In-hospital mortality was 6.2%. One patient (1.1%) had reinfarction and target lesion reintervention the first day as a result of distal dissection and acute vessel occlusion. During follow-up (mean follow-up of 218±75 days), 1 patient died (1.1%), no patient had recurrent myocardial infarction, and there were no additional reinterventions. No early or late stent thromboses were documented. At angiographic follow-up (70%), late loss was -0.04±0.25, and no patient presented angiographic restenosis.
Conclusions— In this study, sirolimus-eluting stent implantation for patients with ST-elevation acute myocardial infarction was safe without documented angiographic restenosis at 6 months.
Key Words: myocardial infarction • drugs • stents • restenosis
