冠状动脉慢性完全闭塞病变和非慢性完全闭塞病变置入西罗莫司洗脱支架再狭窄的临床研究In-stent restenosis in coronary chronic total occlusion lesion and non chronic total occlusion after implantation with sirolimus drug-eluting stent
李甘杨,陈思聪,方勇
摘要(Abstract)：
目的评价冠状动脉慢性完全闭塞病变(CTO)和非CTO病变对西罗莫司(雷帕霉素)洗脱支架(SES)置入1年后支架内再狭窄(ISR)的影响,并分析ISR的预测因素。方法选取2012年1月1日至2013年12月30日置入SES并于1年后回福建医科大学附属龙岩市第一医院心内科复查冠状动脉造影患者357例,根据冠状动脉置入支架前有无完全闭塞和闭塞时间≥3个月分为CTO组80例和非CTO组277例,比较两组患者的临床特征,并采用logistic回归分析评价各变量与ISR的相关性。结果 CTO组患者的年龄[(59.7±9.2)岁比(63.0±9.6)岁,P=0.007]、射血分数[(56.3±11.2)%比(61.3±10.6)%,P=0.000]、非顺应性球囊高压后扩张所占比例[12例(15.0%)比73例(26.4%),P=0.036]均显著低于非CTO组,ISR发生率显著高于非CTO组[18例(22.5%)比36例(13.0%),P=0.037],差异均有统计学意义。多因素logistic逐步回归分析显示,支架置入后非顺应性球囊高压后扩张是患者支架置入1年后ISR的保护因素(OR 0.345,95%CI0.136~0.874,P=0.015)。结论 CTO病变较非CTO病变可能增加支架置入1年后的ISR发生率,支架置入后非顺应性球囊高压后扩张是患者支架置入1年后ISR的保护因素。
关键词(KeyWords)： 冠心病;西罗莫司洗脱支架;慢性完全闭塞病变;支架内再狭窄
基金项目(Foundation):
作者(Author): 李甘杨,陈思聪,方勇
参考文献(References)：
- [1]Erims C,Boz A,Tholakanahalli V,et al.Asesssment of percutaneous coronary interventive on regional and global left venriteular function in patients with chronic total occlusions.Can J Cardiol,2005,21(3):275-280.
- [2]Rahel BM,Suttorp MJ,Laarman GJ,et al.Primary stenting of occluded native coronary arteries:final results of the primary stenting of occluded native coronary arteries(PRISON)study.Am Heart J,2004,147(5):e22.
- [3]Hoffmann R,Mintz GS,Dussaillant GR,et al.Patterns and mechanisms of in-stent restenosis.A serial intravascular ultrasound study.Circulation,1996,94(6):1247-1254.
- [4]Halkin A,Carlier S,Leon MB.Late incomplete lesion coverage following Cypher stent deployment for diffuse right coronary artery stenosis.Heart,2004,90(8):e45.
- [5]Sianos G,Hofma S,Ligthart JM,et al.Stent fracture and restenosis in the drug-eluting stent era.Cathet Cardiovasc Interv,2004,61(1):111-116.
- [6]Hwang CW,Wu D,Edelman ER.Physiological transport forces govern drug distribution for stent-based delivery.Circulation,2001,104(5):600-605.
- [7]Lemos PA,Saia F,Ligthart JMR,et al.Coronary restenosis after sirolimus-eluting stent implantation:morphological description and mechanical analysis from a consecutive series of cases.Acc Current J Review,2003,12(6):257-260.
- [8]Colombo A,Drzewiecki J,Banning A,et al.Randomized study to assess the effectiveness of slow-and moderate-release polymerbased paclitaxel-eluting stents for coronary artery lesions.Circulation,2003,108(7):788-794.
- [9]Valenti R,Vergara R,Migliorini A,et al.Predictors of reocclusion after successful drug-eluting stent-supported percutaneous coronary intervention of chronic total occlusion.J Am Coll Cardiol,2013,61(5):545-550.
- [10]Brodie BR,Cooper C,Jones M,et al.Is adjunctive balloon postdilatation necessary after coronary stent deployment?Final results from the POSTIT trial.Catheter Cardiovasc Interv,2003,59(2):184-192.