药物洗脱支架过度后扩对冠心病患者预后的影响

发布时间：2018-05-02 15:32

  本文选题：药物洗脱支架 + 过度后扩　； 参考：《浙江大学》2017年硕士论文

【摘要】：背景在对某些冠状动脉长病变和分叉病变进行介入治疗时,术者会使用超过支架设计直径的球囊对支架近段进行后扩,即支架的过度后扩。过度后扩应用于药物洗脱支架,可能会改变支架的空间构型,降低支架对病变部位的支撑力度,同时可能损伤药物涂层,影响局部药物浓度,从而对患者的预后产生不良影响。本研究试图评估药物洗脱支架过度后扩对冠心病患者主要不良心血管事件(MACE)发生率的影响。方法本研究选取2013年7月至2016年6月在浙江大学医学院附属邵逸夫医院心内科住院治疗、植入药物洗脱支架、具有完整随访信息的1522名冠心病患者(2514个病变)作为研究对象,排除了既往接受过PCI或CABG以及分叉病变采用双支架技术处理的患者。根据支架是否过度后扩,将研究对象分为过度后扩组(n=624)与非过度后扩组(n=898),比较两组在MACE(死亡、非致死性心肌梗死和靶血管血运重建)发生率上是否存在显著差异。结果两组在性别、年龄、体重指数(body mass index,BMI)、吸烟、高血压、糖尿病、高脂血症、既往心肌梗死、既往卒中、冠心病家族史、临床表现、术前LDL胆固醇、肌酐、空腹血糖等指标上无显著差异。过度后扩组支架个数、支架长度、病变个数、处理的血管数多于非过度后扩组,差异有统计学意义。过度后扩组和非过度后扩组病变所在血管、B2或C型病变的比例(92.6%vs.90.5%,P=0.062)均无显著差异。两组的死亡(2.1%vs.1.8%,P=0.706)、非致死性心肌梗死(4.0%vs.3.1%,P=0.394)、靶病变血运重建(5.3%vs.4.7%,P=0.631)均无显著差异。结论药物洗脱支架过度后扩不会对患者的预后产生显著影响。
[Abstract]:Background in the interventional treatment of some long and branched coronary artery lesions, the balloon larger than the designed diameter of the stent is used to carry out the posterior expansion of the proximal segment of the stent, that is, the excessive posterior expansion of the stent. The application of excessive posterior expansion in drug-eluting stents may change the space configuration of the stents, reduce the support strength of the stents to the diseased sites, at the same time, it may damage the drug coating and influence the local drug concentration, which will have a negative impact on the prognosis of the patients. The aim of this study was to evaluate the effect of drug-eluting stent overexpansion on the incidence of major adverse cardiovascular events (MACEs) in patients with coronary heart disease (CHD). Methods from July 2013 to June 2016, 1522 patients with coronary heart disease (2514 lesions) who were hospitalized in Department of Cardiology, affiliated to run run Shaw Hospital, Zhejiang University Medical College, were implanted with drug-eluting stents. Patients who had previously been treated with PCI or CABG and bifurcation were excluded. According to whether the stent was overexpanded or not, the subjects were divided into two groups: hyperdilation group (n = 624) and non-hyperdilated group (n = 898N). There were significant differences in the incidence of MACE (death, non-fatal myocardial infarction and target vessel revascularization) between the two groups. Results there were two groups: sex, age, body mass index, smoking, hypertension, diabetes, hyperlipidemia, myocardial infarction, stroke, family history of coronary heart disease, clinical manifestation, preoperative LDL cholesterol, creatinine. There was no significant difference in fasting blood glucose and other indexes. The number of stents, the length of stent, the number of lesions and the number of blood vessels treated were more than those of non-overexpansion group, the difference was statistically significant. There was no significant difference in the proportion of type B 2 or type C lesions between the patients with excessive posterior expansion and those with non-excessive posterior expansion. There was no significant difference between the two groups (vs.90.5 P0.062). There was no significant difference between the two groups in terms of blood vessel revascularization (5.3vs.4.7), non-fatal myocardial infarction (4.0vs.3.1P 0.394) and target lesion revascularization (5.3vs.4.7). Conclusion excessive expansion of drug-eluting stents does not significantly affect the prognosis of patients.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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