NGHIÊN cứu HIỆU QUẢ của STENT PHỦ THUỐC TRONG điều TRỊ NHỒI máu cơ TIM cấp

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NGHIÊN CU HIU QU CA STENT PH THUC
U TR NHP

Nguyn Quc Thái, Nguyn Quang Tun, Nguyn Lân Vit
Vin Tim mch Vit Nam- Bnh vin Bch Mai


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

SUMMARY
SIROLIMUS ELUTING STENT VERSUS BARE METAL STENT IN ACUTE
MYOCARDIAL INFARCTION
Objectives: Comparision between sirolimus-eluting stents (SES) and bare-metal stent (BMS)
for treatment of patients with acute myocardial infarction.

Methods: We performed a prospective trial of 216 patients with acute myocardial infarction
assigned to receive SES or BMS. The primary end point is target vessel revascularisation (TVR)
at 12 months angiography follow-up.
Results: During hosptial stay, the rate of successful PCI and death of SES group are 97%;
96.5% and 1%; 1.7% compare with BMS group (p=0.85 and p=0.65). In 12 months follow-up,
the incident of TVR and MACE (Major Adverse Cardiac Events) were lower in the SES group
than BMS group (7% vs. 15.5%, p=0.05 and 9% vs.19.8%, p=0,026; respectively). In the follow-
up time, the incident of TVR and MACE were still lower in the SES group than BMS group (9%
vs. 19%, p=0.037 and 15% vs. 26.7%, p=0,036; respectively).
Conclusions: Among patients with acute myocardial infarction, the use of sirolumus-eluting
stent reduced the rate TVR and MACE at 1 year and follow-up time.


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





 







Tt c các bnh nhân nu tr ni trú ti Vin Tim mch quc gia Vic chn
nh NMCT cp da theo các tiêu chun ca T chc Y t Th gi
Các bc chia làm 2 nhóm:
- Nhóm 1: các bc chnh NMCT cp trong vòng 12 gi k t khi
khc, hoc sau 12 gi nu vn còn triu chng thic nhiu
và/hoc n ST chênh lên nhic tit Stent có ph thuc Sirolimus(
SES: Sirolimus Eluting Stent).
- Nhóm 2: các bnh nhân vi chnh là NMCT cc can thi
da bng (BMS: Bare Metal Stent).
   

 
-






Thầy thuốc trực tiếp hỏi tiền sử, bệnh sử và khám lâm sàng kỹ lưỡng bệnh nhân khi
nhập viện, đặc biệt chú ý dấu hiệu đau ngực, nhịp tim, huyết áp, đánh giá mức độ suy tim
trong giai đoạn cấp của NMCT theo phân độ Killip và làm bệnh án theo mẫu riêng.

Bệnh nhân được làm đầy đủ một số xét nghiệm cơ bản như: men tim, đường máu,
điện giải máu, phức hợp lipid máu, Urê, Créatinin máu, điện tâm đồ, siêu âm Doppler tim
Vic chp và can thii phòng chp mch ca Vin Tim mch Vit nam bng máy
chp mch Infinitive ca hãng Toshiba (Nht bn).
Dng c can thip:


- Johnson&Johnson
  còn

-3).

-
600mg              


415








 
-








Stent) và St

SES (n=100)
BMS (n=116)
p

62,53±10.82
63,34±10,03
0.15

85(85%)
89 (76,7%)
0.2

25 (25%)
14 (12,1%)
0.01
THA, n(%)
61 (61%)
58 (50%)
0.01
RL lipid máu, n( %)
63 (63%)
44 (38%)
<0.001


72 (72%)
71 (61%)
0.15

2 (2%)
2 (1,7%)
0.63
TS TBMN, n(%)
3 (3%)
3 (2,7%)
0.58

15.56
20.8
0.08

22.8
31.8
0.1
Killip I, n(%)
Killip II, n(%)
Killip III, n(%)
85 (85%)
11 (11%)
4 (4%)
89 (76,7%)
26 (22,4%)
1 (0,9%)
0.08
0.02

0.14
CK (UI/l-37
0

CK-MB (UI/l-37
0
C)
2213±1600
209±168
2412±2222
235±262
0.49
0.46
EF, simpson (%)
48,63±13,41
46.08±13,64
0.21
EF<30%, %
26.3
30
0.63




SES (n=100)
BMS (n=116)
p

51

56,0
0,46

26
28,4
0,69

23
15,6
0,16





57
39
4

50
43,1
6,9

0,31
0,54
0,35

96,95 ±5,37
96,05±6,29
0.11




416

SES (n=100)
BMS (n=116)
p

97
96,5
0,85

3,02±0,35
3,10±0,43
0,036

32,08±12,70
30,03±11,8
0.45

16,76±2,85
15,85±3,30
0,137

8 (8%)
16 (3,8%)
0,18

2, n(%)

3, n(%)
79 (79%)
19 (19%)
2 (2%)
84 (72,4%)
29 (25%)
3 (2,6%)
0,26
0,29
0,78

2, n(%)
3, n(%)
1 (1%)
2 (2%)
97 (97%)
1 (0,9%)
3 (2,6%)
112 (96,5%)
0,91
0,77
0,85

2, n(%)
3, n(%)
2 (2%)
3 (3%)
95 (95%)
2 (1,7%)
5 (4,3%)

109 (94%)
0,88
0,61
0,74

1 (1%)
2 (1,7%)
0,65



SES (n=100)
BMS (n=116)
p
Tái NMCT, n(%)
2 (1%)
3 (2,59%)
0,77

0
0


1(1%)
2 (1,7%)
0,65

1 (1%)
5 (4,3%)
0,14


2(2%)
5 (4,3%)
0,34
.







54,9%
54,6%
52,6%
43,9%
p=0,29
p=0,61
p=0,21
p=0,15
p=0,05
p=0,026
p<0,05
p>0,05
p<0,05
417







     

và CK-










Khi so sánh vng v các bin c tim mch chính chúng tôi nhn thy can
thing Stent ph thuc Sirolimus  các bnh nhân NMCT cm 54,9% t l
tái can thi phm (7% so vi 15,5%; p=0,05) và gim 54,6% các bin c tim mch
chính (9% so v khác bit v t l tái
NMCT (SES: 3%; BMS: 6,03%; p=0,29) và t vong (SES: 5%; BMS: 9,48%, p=0,21) (bi 1).
Và kt qu này tip tc duy trì trong quá trình theo dõi: gim 52,6% t l tái can
thi phm và gim 43,9% các bin c tim mch chính (p<0,05). Không khác nhau v t
l t vong (SES: 7%; BMS: 15,29%, p=0,15) và tái NMCT (SES: 6%; BMS: 7,76%; p=0,61)
(bi 2).
Trong nghiên cu SESAMI (Sirolimus-Eluting Stent Versus Bare-Metal Stent in Acute
Myocardial Infarcitonnh nhân NMCT cp ngu
nhiên can thip bp lt qu cho th
làm gim 61% tái can thip ti 11,2%, p=0,02), gim 62% tái can
thi phm (5% so vi 13,1%, p= 0,015), gim 59% các bin c tim mch chính (8,7%

so vi 18,7%; p=0,007). Không có s khác bit v t l t vong và tái NMCT.




- 
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

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