朱玮玮,郭成军,刘现亮,宋洪勇,丁冠桥,赵林

• 1:滨州医学院附属医院心内科
• 2:首都医科大学附属北京安贞医院心内六科
• 3:山东大学齐鲁医院心内科
• 4:中国人民解放军第306医院心内科

摘要(Abstract)：

目的比较药物洗脱支架(DES)治疗支架内再狭窄病变(ISR)与冠状动脉原发病变(De novo)患者的长期临床疗效。方法收集2008年10月至2011年11月在北京安贞医院因ISR接受DES置入治疗的患者作为试验组(ISR组),选择同期因冠状动脉原发病变(De novo)置入DES治疗的患者作为对照组(De novo组)。比较两组患者1年的主要不良心血管事件(MACE),包括全因死亡、心肌梗死(MI)和靶病变血运重建(TLR)。结果 204例患者入选ISR组,494例患者入选De novo组。ISR组糖尿病患病率明显高于De novo组(36.6%比27.1%,P<0.05),ISR组不稳定型心绞痛比例明显低于De novo组(26.0%比70.6%,P<0.01),其余基线资料差异无统计学意义(P>0.05);两组在病变部位、病变类型、病变特点方面比较,差异均无统计学意义(P>0.05),而ISR组支架直径明显小于De novo组,差异有统计学意义[(2.72±0.36)mm比(3.08±0.54)mm,P<0.01)。ISR组MACE发生率明显高于De novo组(21.1%比14.2%,P<0.05),其中,ISR组TLR明显高于De novo组(17.2%比10.7%,P<0.05)。结论 DES治疗ISR患者安全有效,但与治疗冠状动脉原发病变比,TLR明显升高。

关键词(KeyWords)： 药物洗脱支架;冠状动脉原发病变;支架内再狭窄;靶病变血运重建

Abstract:

Keywords:

基金项目(Foundation): 首都医科大学基础与临床合作课题(13JL42)

作者(Author): 朱玮玮,郭成军,刘现亮,宋洪勇,丁冠桥,赵林

参考文献(References)：

• [1]Hao PP,Chen YG,Wang XI,et al.Efficacy and safety of drugeluting stents in patients with acute ST-segment-elevation myocardial infarction:fl meta-analysis of randomized controlled trials.Tex HcartInst,2010,37:516-524.
• [2]Suzuki S,Ishii H,Matsudaira K,et al.Long-Term Outcome of DrugEluting vs.Bare-Metal Stents in Patients With Acute Myocardial Infarction.Circ J,2013,77:2024-2031.
• [3]Almalla M,Schr?der J,Pross V,et al.Everolimus-eluting versus paclitaxel-eluting stents for treatment of bare metal stent restenosis.Am J Cardiol,2011,108:518-522.
• [4]高展,杨跃进,陈纪林,等.药物洗脱支架治疗支架内再狭窄的对照研究.中华内科杂志,2009,48:122-125.
• [5]郑心田,陈康寅,RHA Seung-Woon,等.不同药物洗脱支架在冠状动脉弥漫性长病变中的2年随访结果比较.中国介入心脏病学杂志,2013,21:354-357.
• [6]侯青,乔树宾,高润霖,等.冠状动脉支架术后再狭窄的预测因素.中华心血管病杂志,2005,33:61-64.
• [7]Sato T,Ono T,Morimoto Y,et al.Differences in clinical and angiographic outcomes with different drug-eluting stents in Japanese patients with and without diabetes mellitus.J Cardiol,2012,60:361-366.
• [8]Rathore S,Kaul U.Percutaneous coronary intervention in small coronary vessels:from balloon angioplasty to drug eluting stent era.Indian Heart J,2011,63:228-233.
• [9]Freixa X,Almasood AS,Khan SQ,et al.Choice of stent and outcomes after treatmentof drug-eluting stent restenosis in highly complex lesions.Catheter CardiovascInterv,2013,81:e16-22.
• [10]Williams DO,Holubkov R,Yeh W,et al.Percutaneous coronary intervention in the current era compared with 1985–1986:the National Heart,Lung,and Blood In stitute Registries.Circulation2000,102:2945-2951.
• [11]Grewe PH,Deneke T,Machraoui A,et al.Acute and chronic tissue response to coronary stent implantation:pathologic findings in human specimen.Am Coll Cardiol,2000,35:157-163.
• [12]Hoffmann R,Mintz GS.Coronary in-stent restenosis-predictors,treatment and prevention.Eur Heart J,2000,21:1739-1749.
• [13]Hikita H,Kuroda S,Kawaguchi N,et al.Differential characteristics of inflammatory responses to stent implantation between de novo and intrastent restenosis lesion in patients with stable angina.Angiology,2012,63:92-95.