摘要
目的探讨冠状动脉药物洗脱支架(DES)植入术后支架内再狭窄(ISR)相关因素。方法选择2010年9月至2014年9月上海交通大学医学院附属瑞金医院治疗的连续258例雷帕霉素DES植入术后至少1年冠状动脉造影复查确诊为ISR患者(ISR组)和同期262例年龄和性别匹配但无ISR患者(对照组),比较两组患者临床特征、生化指标、术后用药、超声心动图左室射血分数(LVEF)及DES植入治疗特征,采用多因素Logistic回归方法分析与ISR相关因素。结果与对照组相比,ISR组患者既往心肌梗死史、糖尿病和吸烟多见,血清高敏C反应蛋白(hs-CRP)、糖化血红蛋白、低密度脂蛋白胆固醇(LDL-C)和载脂蛋白B水平显著增高,但LVEF减低(P均<0.05)。尽管两组冠状动脉病变数和支架植入部位无显著差异,但ISR组支架直径较小、长度较长,分叉病变多见(P<0.05)。Logistic回归分析显示既往心肌梗死史、糖尿病、吸烟、hs-CRP、LDL-C、支架长度是ISR独立危险因素,而支架直径、LVEF与ISR呈负相关。结论雷帕霉素DES植入术后ISR发生与多个临床和冠状动脉病变或介入因素相关,有效控制冠心病危险因素、改善左心室功能,对预防ISR具有重要作用,尤其是小血管、长支架和分叉病变患者。
Objective To investigate the factors related to the occurrence of in-stent restenosis（ISR）after percutaneous coronary drug-eluting stent（DES） implantation. Methods A total of 258 consecutive patients with coronary angiography confirmed ISR that occurred at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the Affiliated Ruijin Hospital of Shanghai Jiaotong University during the period from September 2010 to September 2014, were collected as ISR group; and other 260 age-and sex-matched patients with no ISR at least one year after coronary sirolimus-eluting stent implantation, who were encountered at the same hospital and during the same period, were collected as the control group. The clinical characteristics, biochemical measurements, postoperative medications, left ventricular ejection fraction（LVEF）, and coronary interventional features were determined; using multivariate logistic regression analysis the independent factors related to the occurrence of ISR were evaluated. Results Compared to the control group, in ISR group the history of previous myocardial infarction, presence of diabetes mellitus and cigarette smokers were more often seen; serum levels of high-sensitivity C-reactive protein（hs-CRP）, glycosylated hemoglobin, low-density lipoprotein cholesterol（LDL-C）and apoliprotein B in ISR group were significantly increased（P〈0.05）, while LVEF was decreased（P〈0.05）. Although the number of coronary lesions and the site of stent implantation were quite similar in both groups, the stents used in ISRgroup were smaller and longer（P〈0.05）, and bifurcation stenting procedure was more employed in ISR group（P〈0.05）. Multivariate Logistic regression analysis revealed that the history of previous myocardial infarction,diabetes, cigarette smoking, elevated serum hs-CRP and LDL-C levels, and longer stent length were independent risk factors for the occurrence of ISR, whereas stent diameter and LVEF bore a negative correlation with ISR. Conclusion The occurrence of ISR after coronary sirolimus-eluting stent implantation is related to multiple clinical and coronary angiographic and interventional factors. Effective control of risk factors of coronary heart disease and improvement of left ventricular function play an important role in preventing ISR, especially for the patients who has small vessel disease, and in whom longer stents are employed and bifurcation stenting procedure is carried out.
出处
《介入放射学杂志》
CSCD
北大核心
2015年第6期467-471,共5页
Journal of Interventional Radiology
关键词
冠心病
冠状动脉介入治疗
药物洗脱支架
再狭窄
coronary heart disease
percutaneous coronary intervention
drug-eluting stent
restenosis
