Chen Ji-lin, Yang Yue-jin, Qiao Shu-bin, Huang Jing-han, Yao Min, Qin Xue-wen, Xu Bo, Liu Hai-bo, Wu Yong-jian, Gao Run-lin
Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100037, China.
Zhonghua Nei Ke Za Zhi. 2007 Mar;46(3):197-9.
Stent thrombosis has been regarded as a severe complication of PCI therapy, therefore, analyzing the causes of thrombosis after implantation of drug-eluting stents (DES) is necessary.
This is a single center study with no limitation of entry criteria for using DES in patients with coronary heart disease (CHD). From Dec. 2001 to Dec. 2005, 3345 consecutive patients underwent implantation with Cypher stents (eluted with sirolimus: 2165 patients, 2362 lesions, 2695 stents) or TAXUS stents (eluted with paclitaxel: 1180 patients, 1453 lesions, 1725 stents) in our hospital. 10-month follow-up was completed in 2296 patients (1455 patients with 1632 lesions using 1773 Cypher stents & 841 patients with 1032 lesions used 1182 TAXUS stents). All patients were treated with aspirin plus clopidogrel at least 9 months after PCI procedure.
Among 3345 patients, 9 patients had acute stent thrombosis (0.27%): 7 in the sirolimus group, 2 in the paclitaxel group (0.32% vs 0.17%, P = 0.637), 7 patients had subacute stent thrombosis (0.21%): 5 in the sirolimus group and 2 in the paclitaxel group (0.23% vs 0.17%, P = 0.526) and 13 patients had late stent thrombosis (0.57%): 5 in the sirolimus group and 8 in the paclitaxel group (0.34% vs 0.95%, P = 0.114) Among the 29 patients with DES thrombosis. 8 patients (26.7%) presented as sudden death, 13 nonfatal MI and 8 unstable angina. Stent thrombosis was demonstrated by angiography in 21 patients (72.4%). The causes of acute and subacute DES thrombosis were related to suboptimal stenting in 8 patients including 7 patients with bifurcation lesions or to uncovered injury segment of the diffuse lesions in five patients. The causes for late thrombosis were discontinuation of antiplatelet drugs in four cases and related to poor left ventricular function in 6 cases with history of old myocardial infarction.
Our study showed that suboptimal stenting, especially for bifurcation lesions and uncovered injury segment of diffuse lesions were the main causes of acute and subacute stent thrombosis. Left ventricular disfunction and premature discontinuation of antiplatelet therapy were the main reasons of late thrombosis.
支架血栓形成一直被视为经皮冠状动脉介入治疗（PCI）的严重并发症，因此，分析药物洗脱支架（DES）植入术后血栓形成的原因很有必要。
这是一项单中心研究，对冠心病（CHD）患者使用DES没有入组标准限制。2001年12月至2005年12月，我院3345例连续患者接受了Cypher支架（洗脱西罗莫司：2165例患者，2362处病变，2695枚支架）或TAXUS支架（洗脱紫杉醇：1180例患者，1453处病变，1725枚支架）植入。2296例患者（1455例患者使用1632处病变的1773枚Cypher支架，841例患者使用1032处病变的1182枚TAXUS支架）完成了10个月的随访。所有患者在PCI术后至少9个月接受阿司匹林加氯吡格雷治疗。
在3345例患者中，9例发生急性支架血栓形成（0.27%）：西罗莫司组7例，紫杉醇组2例（0.32%对0.17%，P = 0.637）；7例发生亚急性支架血栓形成（0.21%）：西罗莫司组5例，紫杉醇组2例（0.23%对0.17%，P = 0.526）；13例发生晚期支架血栓形成（0.57%）：西罗莫司组5例，紫杉醇组8例（0.34%对0.95%，P = 0.114）。在29例发生DES血栓形成的患者中，8例（26.7%）表现为猝死，13例为非致死性心肌梗死，8例为不稳定型心绞痛。21例患者（72.4%）通过血管造影证实有支架血栓形成。急性和亚急性DES血栓形成的原因与支架植入不理想有关，8例患者包括7例分叉病变患者，5例弥漫性病变患者存在未覆盖的损伤节段。晚期血栓形成的原因4例为停用抗血小板药物，6例有陈旧性心肌梗死病史患者与左心室功能差有关。
我们的研究表明，支架植入不理想，尤其是分叉病变和弥漫性病变未覆盖的损伤节段是急性和亚急性支架血栓形成的主要原因。左心室功能不全和过早停用抗血小板治疗是晚期血栓形成的主要原因。
