支架植入术后非致死性急性心肌梗死的机制：疾病进展、支架再狭窄和支架内血栓形成的相对影响。

Mechanisms of nonfatal acute myocardial infarction late after stent implantation: the relative impact of disease progression, stent restenosis, and stent thrombosis.

机构信息

Cardiology Department, Patras University Hospital, Rio, Patras, Greece.

出版信息

Am Heart J. 2010 Mar;159(3):439-45. doi: 10.1016/j.ahj.2009.12.011.

DOI:10.1016/j.ahj.2009.12.011

PMID:20211307

Abstract

BACKGROUND

The impact of stent restenosis, stent thrombosis, or progression of disease at another site as responsible mechanisms of acute myocardial infarction (AMI) after stent implantation is not clear.

METHODS

By searching our catheterization laboratory database for a 4-year period, 91 cases of nonfatal AMI at least 1 month after stent implantation (32.6% drug-eluting stents) were identified. By detailed comparison of post-AMI with the initial percutaneous coronary intervention angiogram, the mechanism of AMI was analyzed.

RESULTS

Acute myocardial infarction was attributed to disease progression at another site in 42 (46.2%), stent restenosis in 35 (38.4%), and stent thrombosis in 10 (11%) cases. The AMI mechanism could be either stent related or disease progression (nonidentifiable culprit lesion) in 4 cases (4.4%). The median time from percutaneous coronary intervention to AMI was 27, 19, and 9 months for disease progression at another site, restenosis, and stent thrombosis group, respectively (P = .03). ST-elevation myocardial infarction occurred in 38.1% of the disease progression, in 20% of the restenosis, and in 60% of the stent thrombosis cases (P = .046).

CONCLUSIONS

In a "real world" population, late after stent implantation, a patient has an almost equal probability to have suffered a nonfatal AMI from either stent restenosis/thrombosis or disease progression at another site. Continuous research efforts are necessary to equally address both stent therapy and disease progression.

摘要

背景

支架内再狭窄、支架血栓形成或其他部位疾病进展导致支架植入后发生急性心肌梗死（AMI）的机制尚不清楚。

方法

通过对我们的导管实验室数据库进行为期 4 年的搜索，确定了 91 例支架植入后至少 1 个月发生的非致命性 AMI 病例（32.6%为药物洗脱支架）。通过与初始经皮冠状动脉介入治疗血管造影比较，分析 AMI 的发病机制。

结果

急性心肌梗死归因于其他部位疾病进展的有 42 例（46.2%），支架内再狭窄的有 35 例（38.4%），支架血栓形成的有 10 例（11%）。4 例（4.4%）的 AMI 机制既可以是支架相关的，也可以是疾病进展（无法识别的罪犯病变）。从经皮冠状动脉介入治疗到 AMI 的中位时间分别为其他部位疾病进展、再狭窄和支架血栓形成组的 27、19 和 9 个月（P =.03）。病变进展组 ST 段抬高型心肌梗死发生率为 38.1%，再狭窄组为 20%，支架血栓形成组为 60%（P =.046）。