Orford James L, Lennon Ryan, Melby Steven, Fasseas Panayotis, Bell Malcolm R, Rihal Charanjit S, Holmes David R, Berger Peter B
Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
J Am Coll Cardiol. 2002 Nov 6;40(9):1567-72. doi: 10.1016/s0735-1097(02)02374-4.
The study examined the frequency, correlates, and outcome of patients with stent thrombosis within 30 days of stent placement.
Patients in trials evaluating stents or dual antiplatelet therapy to prevent coronary stent thrombosis have generally had narrow inclusion criteria; the extent to which stent thrombosis rates in such trials represent current practice, particularly with the availability of newer stents, is unclear.
We performed a retrospective analysis of the Mayo Clinic Percutaneous Coronary Intervention database and identified all patients who received at least one coronary stent and dual antiplatelet therapy (aspirin and ticlopidine or clopidogrel for two to four weeks).
Four thousand five hundred nine patients underwent successful coronary stent implantation and were treated with dual antiplatelet therapy between July 1, 1994, and April 30, 2000. Stent thrombosis occurred in 23 patients (0.51%; 95% confidence interval 0.32%, 0.76%) within 30 days of stent placement. Multivariate analysis using bootstrap model selection to avoid over-fitting the model indicated that only the number of stents placed was an independent correlate of stent thrombosis (odds ratio 1.80, p < 0.001). The frequency of death and frequency of nonfatal myocardial infarction (MI) among the 23 patients with stent thrombosis were 48% and 39%, respectively.
Stent thrombosis is even more rare in the current era than in earlier trials. Number of stents placed was an independent correlate of stent thrombosis. Most patients who suffer stent thrombosis either die or suffer MI.
本研究调查了支架置入后30天内发生支架血栓形成的患者的频率、相关因素及预后情况。
在评估支架或双联抗血小板治疗以预防冠状动脉支架血栓形成的试验中，患者的纳入标准通常较窄；此类试验中的支架血栓形成率在多大程度上代表了当前的实际情况，尤其是在有更新型支架的情况下，尚不清楚。
我们对梅奥诊所经皮冠状动脉介入治疗数据库进行了回顾性分析，确定了所有接受至少一枚冠状动脉支架和双联抗血小板治疗（阿司匹林和噻氯匹定或氯吡格雷治疗两至四周）的患者。
在1994年7月1日至2000年4月30日期间，4509例患者成功接受了冠状动脉支架植入并接受了双联抗血小板治疗。23例患者（0.51%；95%置信区间0.32%，0.76%）在支架置入后30天内发生了支架血栓形成。使用自助法模型选择以避免模型过度拟合的多变量分析表明，仅置入的支架数量是支架血栓形成的独立相关因素（比值比1.80，p<0.001）。23例发生支架血栓形成的患者中，死亡频率和非致命性心肌梗死（MI）频率分别为48%和39%。
在当前时代，支架血栓形成比早期试验中更为罕见。置入的支架数量是支架血栓形成的独立相关因素。大多数发生支架血栓形成的患者要么死亡，要么发生心肌梗死。
