Mori Shumpei, Yasuda Satoshi, Kataoka Yu, Morii Isao, Kawamura Atsushi, Miyazaki Shunichi
National Cardiovascular Center, Suita, Japan.
Circ J. 2009 Oct;73(10):1856-63. doi: 10.1253/circj.cj-09-0080. Epub 2009 Aug 27.
Sirolimus-eluting stent (SES) has revolutionized interventional cardiology. Its application is spreading to complex, high-risk subsets of patients and lesions. Therefore, it is important to determine the factors associated with post-SES restenosis.
The study investigated 341 patients with angina pectoris, in whom SES was implanted. The coronary artery calcification (CAC) degree was assessed using the angiographic scoring system as follows: 0, none; 1, blocky or spotty calcification; 2, linear calcification compromising 1 side of the arterial lumen; 3, linear calcification found unidirectionally compromising both sides of the arterial lumen; 4, linear calcification found bidirectionally compromising both sides of the arterial lumen; and 5, blanket/circumferential and dense calcification. Restenosis was observed in 23 patients (7.3%). The target lesion (1.8 +/-1.7 vs 0.7 +/-1.1 [mean +/- SD]) and stent delivery route CAC scores (3.1 +/-2.5 vs 1.4 +/-2.0) were significantly higher in patients with restenosis than in those without it (P<0.0001). In multivariate analysis, the CAC score of the stent delivery route was independently associated with restenosis (odds ratio of 6.804, P<0.05), although CAC score of the target lesion was not.
CAC in the stent delivery route is an important determinant of post-SES restenosis.
西罗莫司洗脱支架（SES）彻底改变了介入心脏病学。其应用正在扩展到复杂、高危的患者和病变亚组。因此，确定与SES术后再狭窄相关的因素很重要。
该研究调查了341例植入SES的心绞痛患者。使用血管造影评分系统评估冠状动脉钙化（CAC）程度如下：0，无；1，块状或斑点状钙化；2，线性钙化累及动脉腔一侧；3，单向线性钙化累及动脉腔两侧；4，双向线性钙化累及动脉腔两侧；5，弥漫性/环形致密钙化。23例患者（7.3%）出现再狭窄。再狭窄患者的靶病变（1.8±1.7 vs 0.7±1.1[平均值±标准差]）和支架输送路径CAC评分（3.1±2.5 vs 1.4±2.0）显著高于未出现再狭窄的患者（P<0.0001）。多因素分析中，支架输送路径的CAC评分与再狭窄独立相关（比值比为6.804，P<0.05），而靶病变的CAC评分则不然。
支架输送路径中的CAC是SES术后再狭窄的重要决定因素。
