Abstract: Background　 At present，the proportion of bare metal stents （BMS） implantation in China is less than 5%，which is much lower than that of 30%-40% in the United States and European countries.The reason is that there are few reports on the indications of BMS implantation，and the understanding of BMS is still in its infancy.The indications，efficacy and safety of BMS are questioned in China.Objective　To explore the indications，long-term efficacy and safety of BMS implantations in patients with acute coronary syndrome （ACS）．Methods　A total of 1 203 patients with ACS registered with BMS implantation or drug-eluting stents （DES） were followed up from 2001 to 2010 in Heart Center，Affiliated Hospital of Beihua University，including 491 patients in BMS group and 712 in DES group.All patients were followed up by coronary angiography （CAG） in hospital or CT angiography （CTA） in outpatient department.The follow-up time was（12 to 175）months，with an average follow-up of （71.4±36.4） months.The difference of endpoint events and restenosis rates between the two groups with different pathological types （A，B1，B2，C） were compared.Results　There were no significant differences in the incidence of heart failure，target vessel reconstruction （TVR），and coronary artery bypass grafting （CABG） between the BMS group and the DES group （P>0.05）．The rates of the all-cause death，total major adverse cardiovascular events （MACE） and target lesions revascularization （TLR） in BMS group were significantly higher than those in DES group，and the incidences of recurrent non-fatal myocardial infarction and stent thrombosis （ST） in BMS group were lower than those of DES group （P<0.05）．The rates of the all-cause death，total MACE，recurrent non-fatal myocardial infarction，heart failure，target lesion revascularization （TLR），TVR，ST in patients with coronary type A lesions were not statistically significant between the two groups （P>0.05）．In patients with coronary type B1，B2 and C lesion，all-cause death，total MACE，and TLR in BMS group were significantly higher than those in DES group （P<0.05）．There were no significant differences in the incidence of in-stent restenosis，in-segment restenosis，in-stent restenosis and/or in-segment restenosis between the two groups of patients with coronary type A，B1 lesion （P>0.05）．There was no significant difference in the incidence of in-segment restenosis between the two groups with coronary type B2 and C lesion （P>0.05）．The incidences of in-stent restenosis，in-stent restenosis and/or in-segment restenosis in BMS group were higher than those in DES group with coronary type B2 and C lesion （P<0.05）．Conclusion　The incidence of long-term all-cause death，total MACE，TLR and restenosis in patients with ACS with type A lesion is similar to that of patients with DES.The long-term effect is good and the safety is high.Therefore，ACS with type A lesion can be used as the indication of BMS implantation.

Key words: Acute coronary syndrome, Bare metal stent, Drug-eluting stents, Indications, Follow-up studies, Treatment outcome

摘要： 背景　目前国内植入金属裸支架（BMS）的比例不足5%，远低于美国和欧洲国家的30%~40%。其原因是对植入BMS适应证研究报道较少，BMS的认识还停留在初级阶段。BMS的适应证、效果和安全性受到质疑。目的　探讨急性冠脉综合征（ACS）患者植入BMS的适应证、长期效果和安全性。方法　选取2001—2010年在北华大学附属医院心脏中心住院植入BMS和药物洗脱支架（DES）随访资料完整的ACS患者1 203例为研究对象，其中BMS组491例和DES组712例。患者均住院行冠状动脉造影（CAG）或门诊行CT血管造影（CTA）随访，随访时间为12~175个月，平均随访（71.4±36.4）个月。比较两组不同病变类型（A、B1、B2、C型病变）患者随访终点事件及再狭窄发生率的差异。结果　BMS组与DES组患者心力衰竭、靶血管重建（TVR）、冠状动脉旁路移植术（CABG）发生率比较，差异均无统计学意义（P>0.05）；BMS组患者全因死亡、总主要不良心血管事件（MACE）、靶病变血管重建（TLR）发生率高于DES组，再发非致命性心肌梗死、支架内血栓形成（ST）发生率低于DES组（P<0.05）。两组A型病变患者全因死亡、总MACE、再发非致命性心肌梗死、心力衰竭、TLR、TVR、ST发生率比较，差异均无统计学意义（P>0.05）。BMS组B1型、B2型、C型病变患者全因死亡、总MACE、TLR发生率高于DES组（P<0.05）。两组A型、B1型病变患者支架内再狭窄、节段内再狭窄、支架内再狭窄和/或节段内再狭窄发生率比较，差异均无统计学意义（P>0.05）。两组B2型、C型病变患者节段内再狭窄发生率比较，差异均无统计学意义（P>0.05）；BMS组B2型、C型病变患者支架内再狭窄、支架内再狭窄和/或节段内再狭窄发生率高于DES组（P<0.05）。结论　A型病变ACS患者植入BMS长期全因死亡、总MACE、TLR发生率和再狭窄发生率与DES无差异，远期效果好，安全性高，故可把A型病变ACS作为植入BMS的适应证。

关键词: 急性冠状动脉综合征, 金属裸支架, 药物洗脱支架, 适应证, 随访研究, 治疗结果