冯欢欢,袁晓航,胡鑫,韩燕,张茜,叶豪奕,高磊

• 1:中国人民解放军总医院第一医学中心急诊科
• 2:中国人民解放军医学院
• 3:中国人民解放军总医院第一医学中心心内科

摘要(Abstract)：

目的 评估药物洗脱支架（DES）内复发性支架内再狭窄（R-ISR）发生的预测因素。方法 选择2010年1月至2023年8月在中国人民解放军总医院第一医学中心就诊并接受经皮冠状动脉介入治疗（PCI）的201例支架内再狭窄（ISR）患者作为研究对象，根据出院后造影复查情况将患者分为R-ISR组和非R-ISR组，回顾性分析其首次ISR-PCI时的临床基线资料以及介入手术病变特征。结果 201例患者中男168例，平均年龄（61.97±10.02）岁。中位造影复查间隔时间为1.5年，根据患者造影复查情况将患者分为两组：R-ISR组（98例患者和104处ISR病变）和非R-ISR组（103例患者和111处ISR病变）。多因素Logistic回归分析显示，R-ISR的发生与血管开口病变（OR2.987,95%CI 1.343～6.642,P=0.007）、单纯冠状动脉球囊扩张术（POBA）处理ISR病变（OR 3.081,95%CI 1.293～7.343,P=0.011）以及术前ISR病变最大直径狭窄率（OR1.016,95%CI 1.002～1.030,P=0.022）独立相关。结论 在目前接受介入治疗的ISR患者中，血管开口病变、POBA处理ISR病变以及ISR病变最大直径狭窄率是R-ISR发生的相关预测因素。

关键词(KeyWords)： 经皮冠状动脉介入治疗;药物洗脱支架;支架内再狭窄;复发性支架内再狭窄

Abstract:

Keywords:

基金项目(Foundation): 北京市自然科学基金面上项目（7242138）;; 首都卫生发展科研专项项目（首发2024-2-5072）

作者(Author): 冯欢欢,袁晓航,胡鑫,韩燕,张茜,叶豪奕,高磊

参考文献(References)：

• [1]中国心血管健康与疾病报告编写组.《中国心血管健康与疾病报告2022》概要[J].中国介入心脏病学杂志,2023,31(7):485-508.DOI:10.3969/j.issn.1004-8812.2023.07.002.
• [2]Moussa ID,Mohananey D,Saucedo J,et al.Trends and outcomes of restenosis after coronary stent implantation in the United States[J].J Am Coll Cardiol,2020,76(13):1521-1531.DOI:10.1016/j.jacc.2020.08.002.
• [3]郝伟,赵晨,胡思宁,等.冠状动脉药物洗脱支架内再狭窄的最新研究进展[J].中国介入心脏病学杂志,2023,31(1):63-68.DOI:10.3969/j.issn.1004-8812.2023.01.010.
• [4]Sousa-Uva M,Neumann FJ,Ahlsson A,et al.2018 ESC/EACTS Guidelines on myocardial revascularization[J].Eur J Cardiothorac Surg,2019,55(1):4-90.DOI:10.1093/ejcts/ezy289.
• [5]Lee JM,Rhee TM,Hahn JY,et al.Comparison of outcomes after treatment of in-stent resteno sis using newer generation drugeluting stents versus drug-eluting balloon:Patient-level pooled analysis of Korean Multicenter in-Stent Restenosis Registry[J].Int J Cardiol,2017,230:181-190.DOI:10.1016/j.ijcard.2016.12.176.
• [6]袁晓航,冯欢欢,高磊.复发性支架内再狭窄的研究进展[J].心血管病学进展,2022,43(8):677-679.DOI:10.16806/j.cnkussn.1004-3 934.2022.08.002.
• [7]Mehran R,Dangas G,Abizaid AS,et al.Angiographic patterns of in-stent resteno sis:classification and implications for long-term outcome[J].Circulation,1999,100(18):1872-1878.DOI:10.1161/01.cir.100.18.1872.
• [8]Singh AD,Singal AK,Mian A,et al.Recurrent dru g-eluting stent in-stent resteno sis:a state-of-the-art review of pathophysiology,diagnosis,and management[J].Cardiovasc Revasc Med,2020,21(9):1157-1163.DOI:10.1016/j.carrev.2020.01.005.
• [9]Albiero R,Silber S,Di Mario C,et al.Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis[J].J Am Coll Cardiol,2004,43(6):943-949.DOI:10.1016/j.jacc.2003.09.054.
• [10]Stefanini GG,Alfonso F,Barbato E,et al.Management of myocardial revascularisation failure:an expert consensus document of the EAPCI[J].EuroIntervention,2020,16(11):e875-e890.DOI:10.4244/EIJ-D-20-00487.
• [11]Giacoppo D,Alfonso F.Xu B,et al.Drug-coated balloon angioplasty versus drug-eluting stent implantation in patients with coronary stent restenosis[J].J Am Coll Cardiol,2020,75(21):2664-2678.DOI:10.1016/j.jacc.2020.04.006.
• [12]Giacoppo D,Alfonso F,Xu B,et al.Paclitaxel-coated balloon angioplasty vs.drug-eluting stenting for the treatment of coronary in-stent restenosis:a comprehensive,collaborative,individual patient data meta-analysis of 10 randomized clinical trials(DAEDALUS study)[J].Eur Heart J,2020,41(38):3715-3728.DOI:10.1093/eurheartj/ehz594.
• [13]Koiwaya H,Watanabe N,Kuriyama N,et al.Predictors of recurrent in-stent restenosis after paclitaxel-coated balloon angioplasty[J].Circ J,2017,81(9):1286-1292.DOI:10.1253/circj.CJ-17-0095.
• [14]Cassese S,Xu B,Habara S,et al.Incidence and predictors of recurrent restenosis after drug-coated balloon angioplasty for restenosis of a drug-eluting stent:the ICARUS Cooperation[J].Rev Esp Cardiol(Engl Ed),2018,71(8):620-627.DOI:10.1016/j.rec.2017.08.005.
• [15]Ozawa M,Okamura A,Date M,et al.Third in-stent restenosis in sirolimus eluting stents:predictors of the next restenosis[J].Catheter Cardiovasc Interv,2012,79(1):91-96.DOI:10.1002/ccd.22916.
• [16]Theodoropoulos K,Mennuni MG,Dangas GD,et al.Resistant in-stent restenosis in the drug eluting stent era[J].Catheter Cardiovasc Interv,2016,88(5):777-785.DOI:10.1002/ccd.26559.
• [17]Miura K,Tada T,Habara S,et al.Optical coherence tomography predictors for recurrent restenosis after pactitaxel-coated balloon angioplasty for drug-eluting stent restenosis[J].Circ J,2018,82(11):2820-2828.DOI:10.1253/circj.CJ-18-0464.
• [18]Habara S,Kadota K,Shimada T,et al.Late restenosis after paclitaxel-coated balloon angioplasty occurs in patients with drugeluting stent Restenosis[J].J Am Coll Cardiol,2015,66(1):14-22.DOI:10.1016/j.jacc.2015.05.002.
• [19]Shlofmitz E,Iantorno M,Waksman R.Restenosis of drugeluting stents:a new classification system based on disease mechanism to guide treatment and state-of-the-art review[J].Circ Cardiovasc Interv,2019,12(8):e007023.DOI:10.1161/CIRCINTERVENTIONS.118.00702 3.
• [20]Klein LW,Nathan S,Maehara A,et al.SCAI expert consensus statement on management of in-stent restenosis and stent thrombosis[J].J Soc Cardiovasc Angiogr Interv,2023,2(4):100971.DOI:10.1016/j.jscai.2023.100971.
• [21]Ng J,Bourantas CV,Torii R,et al.Local hemodynamic forces after stenting:implications on restenosis and thrombosis[J].Arterioscler Thromb Vasc Biol,2017,37(12):2231-2242.DOI:10.1161/ATVBAHA.117.309728.
• [22]Bidula S,Dhuna K,Helliwell R,et al.Positive allosteric modulation of P2X7 promotes apoptotic cell death over lytic cell death responses in macrophages[J].Cell Death Dis,2019,10(12):882.DOI:10.1038/s41419-019-2110-3.
• [23]Jukema JW,Verschuren JJ,Ahmed TA,et al.Restenosisafter PCI.Part 1:pathophysiology and risk factors[J].Nat Rev Cardiol,2011,9(1):53-62.DOI:10.1038/nrcardio.2011.132.
• [24]Scott NA.Restenosis following implantation of bare metal coronary stents:pathophysiology and pathways involved in the vascular response to injury[J].Adv Drug Deliv Rev,2006,58(3):358-376.DOI:10.1016/j.addr.2006.01.015.
• [25]Pelliccia F,Zimarino M,Niccoli G,et al.In-stent restenosis after percutaneous coronary intervention:emerging knowledge on biological pathways[J].Eur Heart J Open,2023,3(5):oead083.DOI:10.1093/ehjopen/oead083.
• [26]冯六六,钱菊英,周明成,等.血清C反应蛋白对冠状动脉支架置入术后心血管事件和再狭窄的预测价值[J].中华心血管病杂志,2003,31(7):514-516.DOI:10.3760/j:issn:0253-3758.2003.07.010.
• [27]王成钢,王春梅,阙斌,等.C反应蛋白水平对冠状动脉支架内再狭窄的预测价值[J].中华老年心脑血管病杂志,2020,22(2):149-152.DOI:10.3969/j.issn.1009-0126.2020.02.010.
• [28]Lasave LI,Abizaid AA,Paiva e Maia J,et al.Relationship between plasma C-reactive protein level and neointimal hyperplasia volume in patients with zotarolimus-eluting stents.Volumetric analysis by three-dimensional intracoronary ultrasound[J].Rev Esp Cardiol,2007,60(9):923-931.DOI:10.1157/13109645.
• [29]Raber L,Mintz GS,Koskinas KC,et al.Clinical use of intracoronary imaging,part 1:guidance and optimization of coronary interventions.an expert consensus document of the European Association of Percutaneous Cardiovascular Interventions[J].Eur Heart J,2018,39(35):3281-3300.doi:10.1093/eurheartj/ehy285.
• [30]刘长福,陈韵岱,陈练,等.光学相干断层成像评价国产新型药物洗脱支架术后内膜增殖[J].南方医科大学学报,2010,30(5):1063-1065.DOI:10.12122/j.issn.1673-4254.2010.05.051.