Clarkson P B, Halim M, Ray K K, Doshi S, Been M, Singh H, Shiu M F
Department of Cardiology, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2, UK.
Heart. 1999 Apr;81(4):393-7. doi: 10.1136/hrt.81.4.393.
To compare early complication rates in unselected cases of coronary artery stenting in patients with stable v unstable angina.
Tertiary referral centre.
390 patients with stable angina pectoris (SAP) and 306 with unstable angina (UAP). Patients treated for acute myocardial infarction (primary angioplasty) or cardiogenic shock were excluded.
268 coronary stents were attempted in 211 patients (30.3%). Stents used included AVE (63%), Freedom (14%), NIR (7%), Palmaz-Schatz (5%), JO (5%), and Multilink (4%). Intravascular ultrasound was not used in any of the cases. All stented patients were treated with ticlopidine and aspirin together with periprocedural unfractionated heparin.
123 stents were successfully deployed in 99 SAP patients v 132 stents in 103 UAP patients. Failed deployment occurred with nine stents in SAP patients, v four in UAP patients (NS). Stent thrombosis occurred in four SAP patients and 11 UAP patients. Multivariate analysis showed no relation between stent thrombosis and clinical presentation (SAP v UAP), age, sex, target vessel, stent length, or make of stent. Stent thrombosis was associated with small vessel size (p < 0.001) and bailout stenting (p = 0.01) compared with elective stenting and stenting for suboptimal PTCA, with strong trends toward smaller stent diameter (p = 0.052) and number of stents deployed (p = 0.06). Most stent thromboses occurred in vessels < 3 mm diameter.
Coronary artery stenting in unstable angina is safe in vessels >/= 3 mm diameter, with comparable initial success and stent thrombosis rates to stenting in stable angina.
比较稳定性与不稳定性心绞痛患者未经筛选的冠状动脉支架置入术的早期并发症发生率。
三级转诊中心。
390例稳定性心绞痛（SAP）患者和306例不稳定性心绞痛（UAP）患者。排除接受急性心肌梗死治疗（直接血管成形术）或心源性休克的患者。
211例患者（30.3%）尝试置入268个冠状动脉支架。使用的支架包括AVE（63%）、Freedom（14%）、NIR（7%）、Palmaz-Schatz（5%）、JO（5%）和Multilink（4%）。所有病例均未使用血管内超声。所有置入支架的患者均接受噻氯匹定和阿司匹林治疗，并在围手术期使用普通肝素。
99例SAP患者成功置入123个支架，103例UAP患者成功置入132个支架。SAP患者有9个支架置入失败，UAP患者有4个支架置入失败（无显著性差异）。4例SAP患者和11例UAP患者发生支架血栓形成。多变量分析显示，支架血栓形成与临床表现（SAP与UAP）、年龄、性别、靶血管、支架长度或支架类型无关。与选择性支架置入术和非最佳经皮腔内冠状动脉成形术（PTCA）置入支架相比，支架血栓形成与小血管直径（p<0.001）和补救性支架置入术（p=0.01）相关，有支架直径较小（p=0.052）和置入支架数量较多（p=0.06）的强烈趋势。大多数支架血栓形成发生在直径<3mm的血管中。
对于直径≥3mm的血管，不稳定性心绞痛患者的冠状动脉支架置入术是安全的，其初始成功率和支架血栓形成率与稳定性心绞痛患者的支架置入术相当。
