Sheiban I, Leonardo F, Rosano G M, Pagnotta P, Marsico F, Montorfano M, Di Mario C, Trevi G, Colombo A
Department of Internal Medicine, University of Turin, Italy.
Ital Heart J. 2000 Jul;1(7):480-6.
Coronary artery stenting reduces the restenosis rate compared to coronary angioplasty alone. With the increased number of procedures completed with stent placement there has been a parallel increase in the number of procedures performed in patients with multivessel disease and therefore a rise in the number of patients receiving multiple stents. The clinical outcome and the predictors of the outcome of patients receiving multiple stents are not known.
To evaluate the clinical outcome of patients with multivessel coronary artery disease undergoing multiple stenting we studied 133 consecutive patients who had received > 1 stent in at least two vessels. A total of 375 coronary stents (2.8 stent per patient) were implanted in elective procedure situations. Clinical follow-up was complete in 100%.
During follow-up 2 patients (1.5%) died (1 cardiac death), 4 patients (3%) had acute myocardial infarction, 96 patients (72.1%) remained angina-free, and 31 patients (23.3 %) had recurrence of angina. Repeat revascularization procedure was performed in 45 patients (33.8%); 43 patients (32.3%) underwent coronary angioplasty; 2 patients (1.5%) underwent coronary artery bypass grafting. The female gender and the presence of diabetes were significant (p < 0.05) predictors for coronary angioplasty or coronary artery bypass grafting procedures during follow-up. Recurrence of angina was also significantly (p < 0.05) associated with unstable angina at the time of the first procedure as well as diabetes and the female gender. Diabetes, the female gender and unstable angina were highly predictive factors of major adverse cardiac events during follow-up.
Multiple vessel stenting in patients with multivessel coronary artery disease is associated with an acceptable immediate and long-term clinical outcome and could be considered as an alternative therapeutic option in these patients. Predictors of an adverse long-term outcome are the female gender and the presence of diabetes mellitus.
与单纯冠状动脉血管成形术相比，冠状动脉支架置入术可降低再狭窄率。随着支架置入手术数量的增加，多支血管病变患者接受的手术数量也相应增加，因此接受多个支架的患者数量也有所上升。接受多个支架的患者的临床结局及结局预测因素尚不清楚。
为评估接受多支冠状动脉支架置入术的多支血管冠状动脉疾病患者的临床结局，我们研究了133例连续患者，这些患者至少在两支血管中置入了1个以上支架。在择期手术情况下共植入了375个冠状动脉支架（每位患者2.8个支架）。临床随访完成率为100%。
随访期间，2例患者（1.5%）死亡（1例心源性死亡），4例患者（3%）发生急性心肌梗死，96例患者（72.1%）无心绞痛发作，31例患者（23.3%）心绞痛复发。45例患者（33.8%）接受了再次血运重建手术；43例患者（32.3%）接受了冠状动脉血管成形术；2例患者（1.5%）接受了冠状动脉旁路移植术。女性及糖尿病的存在是随访期间冠状动脉血管成形术或冠状动脉旁路移植术的显著（p<0.05）预测因素。心绞痛复发也与首次手术时的不稳定型心绞痛以及糖尿病和女性显著（p<0.05）相关。糖尿病、女性及不稳定型心绞痛是随访期间主要不良心脏事件的高度预测因素。
多支血管冠状动脉疾病患者的多支血管支架置入术具有可接受的近期和长期临床结局，可被视为这些患者的一种替代治疗选择。长期不良结局的预测因素为女性及糖尿病的存在。
