急性冠状动脉综合征是西罗莫司洗脱支架植入术后晚期支架贴壁不全的独立危险因素。

Acute coronary syndrome is an independent risk factor for late incomplete stent apposition after sirolimus-eluting stent implantation.

作者信息

Zhang Rui-yan, DU Run, Zhu Zheng-bin, Zhang Qi, Hu Jian, Lü An-kang, Zhang Jian-sheng, Shen Wei-feng

机构信息

Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Chin Med J (Engl). 2008 Dec 20;121(24):2504-8.

PMID:19187586

Abstract

BACKGROUND

Late incomplete stent apposition (ISA) may occur after drug-eluting stent implantation, affecting long-term clinical outcomes. This study aimed to evaluate the impact of clinical presentations of coronary artery disease on late ISA after percutaneous coronary intervention (PCI) with sirolimus-eluting stents (SES) by means of three-dimensional volumetric intravascular ultrasound (IVUS) analyses.

METHODS

One hundred and thirty-seven patients with coronary artery disease received SES implantation during PCI and had repeat angiography with IVUS examination. All patients were followed up one year after the procedure.

RESULTS

In overall 219 treated lesions (137 patients), late ISA was identified in 25 lesions (16 patients). Clinical diagnosis of acute coronary syndrome (ACS) and use of long stents were more common in patients with than in those without late ISA. Patients with late ISA had greater external elastic membrane (EEM) area in stented segment ((15.34 +/- 5.44) vs (13.83 +/- 4.51) mm(2), P = 0.026), stented-to-reference segment EEM area ratio (1.13 +/- 0.22 vs 1.02 +/- 0.18, P < 0.001), and plaque and media area ((8.43 +/- 3.93) vs (7.01 +/- 2.93) mm(2), P = 0.002) than in those without late ISA. Multivariate Logistic regression analysis showed that clinical diagnosis of ACS and use of long stents were independent risk factors for late ISA (OR 6.477, 95% CI 2.297 - 18.263, P < 0.001; OR 3.680, 95% CI 1.181 - 11.469, P = 0.025; respectively). During one-year follow-up after IVUS examination, the rate of very late stent thrombosis tended to be higher in patients with than in those without late ISA (18.7% vs 3.3%, P = 0.051).

CONCLUSIONS

The occurrence of late ISA after SES implantation may be related to clinical status, use of long stents, and marked positive vessel remodeling. Late ISA tended to increase the rate of very late stent thrombosis during follow-up, highlighting the importance of long-term dual antiplatelet therapy for these patients.

摘要

背景

药物洗脱支架植入后可能会出现晚期不完全支架贴壁（ISA），影响长期临床结局。本研究旨在通过三维容积血管内超声（IVUS）分析，评估冠心病临床表现对西罗莫司洗脱支架（SES）经皮冠状动脉介入治疗（PCI）后晚期ISA的影响。

方法

137例冠心病患者在PCI期间接受了SES植入，并进行了重复血管造影及IVUS检查。所有患者在术后随访1年。

结果

在总共219个治疗病变（137例患者）中，25个病变（16例患者）发现了晚期ISA。有晚期ISA的患者中急性冠状动脉综合征（ACS）的临床诊断和长支架的使用比没有晚期ISA的患者更常见。有晚期ISA的患者支架段的外弹力膜（EEM）面积更大（（15.34±5.44）对（13.83±4.51）mm²，P = 0.026），支架段与参照段EEM面积比（1.13±0.22对1.02±0.18，P < 0.001），以及斑块和中膜面积（（8.43±3.93）对（7.01±2.93）mm²，P = 0.002）均大于没有晚期ISA的患者。多因素Logistic回归分析显示，ACS的临床诊断和长支架的使用是晚期ISA的独立危险因素（OR 6.477，95%CI 2.297 - 18.263，P < 0.001；OR 3.680，95%CI 1.181 - 11.469，P = 0.025；分别）。在IVUS检查后的1年随访期间，有晚期ISA的患者极晚期支架血栓形成率往往高于没有晚期ISA的患者（18.7%对3.3%，P = 0.051）。