Niccoli Giampaolo, Conte Micaela, Cosentino Nicola, Todaro Daniel, Brugaletta Salvatore, Montone Rocco Antonio, Minelli Silvia, Fracassi Francesco, Galiffa Vincenzo, Leone Antonio Maria, Burzotta Francesco, Porto Italo, Trani Carlo, Crea Filippo
Catholic University of the Sacred Heart, Cardiovascular Medicine, L.go F. Vito 1, Rome 00168, Italy.
J Invasive Cardiol. 2011 Jan;23(1):16-20.
A diffuse pattern of in-stent restenosis (ISR) has been shown to have a worse prognosis when compared to a focal pattern. It is still unknown whether baseline C-reactive protein (CRP) levels predict ISR pattern.
Our database was searched retrospectively for patients presenting with ISR after m-TOR inhibitor drug-eluting stent (DES) implantation from January 2007 to December 2009. Angiographic restenosis patterns were evaluated according to the simplified Mehran classification and patients were allocated either to the diffuse or focal pattern group. Predictors of restenosis pattern were assessed among clinical, angiographic, procedural and laboratory data, including baseline high-sensitivity CRP, recorded at the time of the first percutaneous intervention.
72 patients (age, 65 ± 9 years; male sex, 64%) found to have ISR after DES implantation were enrolled. 34 patients presented with a focal pattern, whereas 38 patients presented with a diffuse pattern. At multivariate analysis, CRP levels were the only independent predictor of a diffuse ISR pattern [odds ratio, 2.5; 95% confidence interval, 1.4-4.3; p = 0.001)]. Rising CRP tertiles were associated with an increased rate of diffuse pattern (13% versus 26% versus 61%; p for trend = 0.0001).
Baseline CRP serum levels are associated with a diffuse ISR pattern after m-TOR inhibitor DES implantation. These findings suggest that baseline inflammatory reactivity may contribute to aggressive restenosis occurring despite drug elution.
与局灶性模式相比，支架内再狭窄（ISR）的弥漫性模式已被证明预后更差。基线C反应蛋白（CRP）水平是否能预测ISR模式仍不清楚。
我们对2007年1月至2009年12月间接受m-TOR抑制剂药物洗脱支架（DES）植入术后出现ISR的患者数据库进行了回顾性检索。根据简化的梅兰分类法评估血管造影再狭窄模式，患者被分为弥漫性或局灶性模式组。在临床、血管造影、手术和实验室数据中评估再狭窄模式的预测因素，包括首次经皮介入时记录的基线高敏CRP。
纳入72例DES植入术后出现ISR的患者（年龄65±9岁；男性64%）。34例患者表现为局灶性模式，38例患者表现为弥漫性模式。在多变量分析中，CRP水平是弥漫性ISR模式的唯一独立预测因素[比值比，2.5；95%置信区间，1.4 - 4.3；p = 0.001]。CRP三分位数升高与弥漫性模式发生率增加相关（13%对26%对61%；趋势p = 0.0001）。
基线CRP血清水平与m-TOR抑制剂DES植入术后的弥漫性ISR模式相关。这些发现表明，尽管有药物洗脱，但基线炎症反应性可能导致侵袭性再狭窄的发生。
