摘要
目的分析冠心病患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的影响因素。方法选取2007年1月至2016年1月在遵义医学院附属医院心内科成功行支架植入术的冠心病患者1342例,依据复查造影结果分为ISR组(89例)和非ISR组(1253例)。回顾性分析两组患者病史资料、血液生物化学指标、心脏超声指标、冠状动脉病变、支架情况、服药情况及主要不良心血管事件(MACE)等,采用多因素Logistic回归分析其与冠状动脉支架术后ISR的关系。结果入选患者ISR发生率为6.6%。ISR组糖尿病患病率、术后吸烟率、停用阿司匹林、1年内停用氯吡格雷患者比例明显高于非ISR组(P<0.05);ISR组服用大剂量他汀患者比例低于非ISR组(P<0.05)。ISR组复杂病变、串联支架数高于非ISR组(P<0.05);ISR组植入支架长度较非ISR组长(28.43±6.58 mm比26.27±7.08 mm,P=0.001);ISR组植入支架直径(2.92±0.41 mm比3.04±0.43 mm,P=0.003)、术后最小管腔内径(MLD)(2.44±0.34 mm比2.57±0.35 mm,P<0.001)较非ISR组偏小;ISR组术后直径狭窄率高于非ISR组(8.46%比7.60%,P=0.018);ISR组早期获得低于非ISR组(1.77±0.43 mm比1.87±0.43 mm,P=0.043)。多因素Logistic回归分析显示,糖尿病、术后吸烟、停用阿司匹林、支架长度、支架直径、串联支架、术后MLD、术后直径狭窄率为冠状动脉支架术后ISR的独立危险因素。随访至8个月发现,ISR组复发心绞痛、靶病变再次血运重建(TLR)、复合MACE发生率明显高于非ISR组(P<0.001);随访至1年发现,ISR组复发心绞痛、TLR、心肌梗死(MI)、复合MACE发生率明显高于非ISR组(P<0.05)。ISR组支架血栓发生率明显高于非ISR组(P<0.001)。结论糖尿病、吸烟、停用阿司匹林、支架直径、支架长度、串联支架、术后MLD、术后直径狭窄率是PCI术后ISR的危险因素,PCI术后ISR可能增加MACE发生率。
Aim To investigate the related factors of in-stent restenosis（ ISR） after percutaneous coronary intervention（ PCI） in patients with coronary heart disease（ CHD）. Methods A total of 1342 CHD patients who received PCI in our hospital from January 2007 to January 2016 were studied. These patients were divided into ISR group（ ≥50%diameter stenosis of in-stent） and non-ISR group according to the result of coronary angiography（ CAG）. The ISR group included 89 patients（ 94 with lesions）, and the non-ISR group included 1253 patients（ 1754 with lesions）.Retrospective analysis of their blood biochemical index,echocardiographic index,coronary artery lesions,stents,medication compliance and major adverse cardiac events were made by multivariate models to predict the occurrence of ISR.Results The incidence of ISR was 6. 6% in the selected patients. The prevalence of diabetes,smoking rate,patients with the discontinuation of clopidogrel in 1 year and discontinuation of aspirin were significantly higher in ISR group,as compared with non-ISR group（ P 0. 05）. Patients in ISR group taking adequate statin was more than that of non-ISR group（ P〈0.05）. The complex lesions,reference vessel diameter before procedure,serial stents in ISR group were higher than those in non-ISR group（ P〈0.001）,the stent length was longer in ISR group than that in non-ISR group（ 28.43±6.58 mm vs. 26.27±7.08 mm,P = 0.001）,the stent diameter（ 2.92±0.41 mm vs. 3.04±0.43 mm,P = 0.003） and postoperative minimal lumen diameter（ MLD）（ 2.44±0.34 mm vs. 2.57±0.35 mm,P〈0.001） were smaller and the percent of diameter stenosis（ 8.46% vs. 7.60%,P = 0. 018） was significantly greater in ISR group than those in non-ISR group. The acute gain was lower in ISR group than that in non-ISR group（ 1.77±0.43 mm vs. 1.87±0.43 mm,P = 0.043）. Multiariable Logistic regression analysis showed that diabetes,smoking,discontinuing aspirin,diameter or length of previously implanted drug-eluting stents（ DES）,postoperative MLD,serial stents,and the percent of diameter stenosis were independent risk factors for restenosis after PCI（ P〈0.05）. In an 8 months follow-up,the incidence of recurrent angina,target lesion revascularization（ TLR） and combined major adverse cardiovascular events（ MACE） in ISR group was significantly higher（ P〈0.001）. In the 1 year follow-up,the incidence of recurrent angina,myocardial infarction（ MI）,TLR,composite MACE were significantly higher in ISR group（ P〈0.05）. The incidence of stent thrombosis was significantly higher in ISR group（ P〈0.001）. Conclusions Diabetes,smoking,discontinuing aspirin,the diameter or length of previously implanted DES,serial stents,postoperative MLD and the percent of diameter stenosis are risk factors for the development of ISR. Restenosis after PCI may increase the incidence of MACE.
出处
《中国动脉硬化杂志》
CAS
北大核心
2017年第3期278-283,共6页
Chinese Journal of Arteriosclerosis
关键词
冠心病
经皮冠状动脉介入治疗
支架内再狭窄
危险因素
Coronary heart disease
Percutaneous coronary intervention
In-stent restenosis
Risk factors
作者简介
邓婵翠，硕士，住院医师，主要从事冠心病介入治疗，E—mail为714662148@qq．com。
通讯作者石蓓，教授，硕七研究生导师，主要从事冠心病介入治疗与再狭窄研究，E-mail为shibei2147@163．com。
