冠心病PCI术后支架内再狭窄的相关因素分析

发布时间：2018-06-06 16:05

本文选题：冠心病 + 经皮冠状动脉介入治疗　；参考：《中国动脉硬化杂志》2017年03期

【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(P0.05);ISR组服用大剂量他汀患者比例低于非ISR组(P0.05)。ISR组复杂病变、串联支架数高于非ISR组(P0.05);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,P0.001)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(P0.001);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(P0.05)。ISR组支架血栓发生率明显高于非ISR组(P0.001)。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。
[Abstract]:Objective to analyze the influencing factors of ISR after percutaneous coronary intervention (PCI) in patients with coronary heart disease. Methods from January 2007 to January 2016, 1342 patients with coronary heart disease (CHD) who successfully underwent stenting in Department of Cardiology, affiliated Hospital of Zunyi Medical College, were divided into two groups according to the results of re-examination: 89 cases in ISR group and 1253 cases in non-ISR group. The history, biochemical indexes, echocardiographic parameters, coronary artery lesions, stents, medication and major adverse cardiovascular events were retrospectively analyzed in the two groups. Multivariate logistic regression analysis was used to analyze the relationship between ISR and ISR after coronary stenting. Results the prevalence of diabetes, smoking, aspirin and clopidogrel in the ISR group was significantly higher than that in the non-ISR group (P 0.05) and the rate of high dose statins in the ISR group was lower than that in the non-ISR group (P 0.05N. ISR group), and the rate of complicated lesions in the non-ISR group was significantly higher than that in the non-ISR group. The number of series stents was higher than that of the non-ISR group (28.43 卤6.58 mm vs 26.27 卤7.08 mm). The diameter of stent in ISR group was 2.92 卤0.41 mm vs 3.04 卤0.43 mm P0. 003, and the minimum lumen diameter was 2.44 卤0.34 mm vs 2.57 卤0.35 mm P0.001). In the non-ISR group, 8.46% was lower than 7.60% in the early stage of ISR, and 1.77 卤0.43 mm in the non-ISR group, 1.87 卤0.43 mm in the non-ISR group. Multivariate logistic regression analysis showed that diabetes, smoking, stopping aspirin, stent length, stent diameter, series stent, postoperative MLDand postoperative diameter stenosis rate were the independent risk factors of ISR after coronary stenting. Follow-up for 8 months revealed recurrent angina pectoris in the ISR group. The incidence of combined Mace in target lesions was significantly higher than that in non-ISR group (P 0.001), and the incidence of recurrent angina pectoris, myocardial infarction and Mace in ISR group was significantly higher than that in non-ISR group (P 0.05) and non-ISR group (P 0.001). Conclusion Diabetes mellitus, smoking, stop aspirin, stent diameter, stent length, series stent, postoperative MLDand postoperative diameter stenosis rate are risk factors of ISR after PCI. ISR after PCI may increase the incidence of Mace.
【作者单位】：遵义医学院附属医院心血管内科;
【分类号】：R541.4

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