MIDAS: DES Significantly Reduced All-Cause and Cardiovascular Mortality

　　新泽西MIDAS 注册登记研究结果首次在TCT2007上公布。Tudor D. Vagaonescu教授说，“MIDAS的2003－2004数据库中，急性心肌梗死应用DES 和裸金属支架相比可以显著降低2年的死亡率、全因死亡率和心血管死亡率。”该研究入选急性心肌梗死患者，比较DES组（n＝5719）和裸金属支架组（n＝5399）的死亡率。在2年随访中DES组总生存率是90.2％，BMS组85.2％，无心血管死亡生存率在DES组和BMS组分别是96.2％和92.3％，均达到了统计学差异。

　　两组中总的基线特征相似，要提出的是BMS组STEMI 的比例为54.4%，DES组为38.8%。Non-STEMI在 DES组和BMS组中分别为55.7%，40.7%。研究者比较了非STEMI患者DES和BMS 的总体无心血管死亡的生存率，发现DES 更好，两组分别是96.2%和92.3%，有统计学差异，NSTEMI 中总的生存率DES和BMS组分别是90.2%和85.2%。

　　住院并发症包括急性心肌梗死、心律失常和左室功能不全在BMS组更高，而两组左室功能不全的比例相似。Vagaonescu说“DES尽管可以降低TLR和TVR，但在急性心肌梗死的应用中因为晚期支架血栓的问题而存在争议。”该研究的亮点之一是为超过了11000例单一支架的群体研究，其他优点包括所有患者完成了2年随访。

　　但是也有几个不足，一个是以病历为基础的观察性研究，可能存在很多个未能校正的混杂因素，包括基线差异、药物治疗以及二联抗血小板持续时间。

　　（武警总医院　韩玮　编译）

MIDAS: DES Significantly Reduced All-Cause and Cardiovascular Mortality

Two-year data demonstrate benefits of DES in patients with STEMI & non-ST elevation MI.

Observational results from the New Jersey MIDAS registry were presented for the first time at TCT 2007.

“In the MIDAS database for 2003-2004, the use of DES in the setting of acute MI was associated with significant reductions of 2-year, all-cause death and cardiovascular mortality when compared with the use of baremetal stents,” said Tudor D. Vagaonescu,MD, PhD.

Researchers from Robert Wood Johnson Medical School in New Brunswick, NJ, where Vagaonescu is
an assistant professor of cardiology in the Department of Cardiovascular Diseases and Hypertension, compared mortality in patients with MI who underwent PCI with placement of a single DES (n = 5,719) or baremetal stent (n = 5,399).

At 2 years, overall survival was 90.2% in DES patients and 85.2% in bare-metal stent patients (P<.0001). And overall survival free from cardiovascular death was 96.2% in DES patients and 92.3% with bare-metal stents (P<.0001) over the same time period.

Patient characteristics were generally similar at baseline. Of note, 54.4% of patients treated with baremetal stents had STEMI, as did 38.8% of DES-treated patients.

Non-STEMI was reported more among DES-treated patients (55.7%) compared with bare-metal stent-treated patients (40.7%).

When the researchers compared DES and bare-metal stents to determine overall survival free from
cardiovascular death in patients with non-STEMI, DES-treated patients fared better; 96.2% for DES vs. 92.3% for bare-metal stents (HR 0.54; P<.0001). Overall survival was 90.2% for DES and 85.2% for baremetal stents in non-ST-elevation MI (HR 0.70; P<.0001).

In-hospital complications including acute MI, arrhythmia, and leftventricular dysfunction and arrhythmia
combinedwere higher with bare-metal stents, while left-ventricular dysfunction alone was similar between the stents.

“The use of DES, despite decreasing the rates of TLR and TVR when compared with bare-metal stents, is considered controversial in acute MI due to late-stent thrombosis,”said Vagaonescu.

One strength of this analysis is that it is a population-based study of more than 11,000 single-stent PCIs,
Vagaonescu said. He mentioned several other strengths, including complete 2-year follow-up on all patients and all PCIs regardless of success or failure of revascularization.

However, there are several limitations. For one, it was an observational study that used administrative
data. Vagaonescu said there may be unmeasured confounding factors that contribute to the present findings, such as unknown baseline differences, medical management, and differences in duration of dual antiplatelet therapy.