治疗后临床冠状动脉支架内再狭窄随访及临床结局分析

Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes.

作者信息

Marino Barbara Campos Abreu, Nascimento Guilherme Abreu, Rabelo Walter, Marino Marcos Antônio, Marino Roberto Luiz, Ribeiro Antonio Luiz Pinho

机构信息

Programa de Pós-Graduação em Ciências da Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil.

Departamento de Cardiologia Intervencionista, Hospital Madre Teresa, Belo Horizonte, Minas Gerais, Brasil.

出版信息

Arq Bras Cardiol. 2015 May;104(5):375-86. doi: 10.5935/abc.20140216. Epub 2015 Feb 3.

DOI:10.5935/abc.20140216

PMID:25651344

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4495452/

Abstract

BACKGROUND

Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation.

OBJECTIVE

Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment.

METHODS

We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year.

RESULTS

Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44-12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53-44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75-9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35-29.38]; p = 0.019) emerged as predictors of a secondary outcome.

CONCLUSION

Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

摘要

背景

临床支架内再狭窄（CISR）是冠状动脉支架植入术的主要局限性。

目的

描述CISR的临床和血管造影特征以及诊断和治疗后至少12个月随访期内的结果。

方法

我们分析了110例连续性CISR患者的临床表现、血管造影特征、治疗方法以及在至少一年的随访期内的主要联合结局（心血管死亡、非致死性急性心肌梗死[AMI]）和次要联合结局（因不稳定型心绞痛住院、靶血管血运重建和靶病变血运重建）。

结果

平均年龄为61±11岁（男性占68.2%）。临床表现包括62.7%的急性冠状动脉综合征（ACS）和34.5%的增殖性支架内再狭窄。CISR的治疗方法包括36.4%植入药物洗脱支架（DES）、2,36%植入裸金属支架（BMS）、18.2%进行心肌血运重建手术、15.5%进行球囊血管成形术以及6.4%进行临床治疗。在中位随访期19.7个月内，18例患者出现主要结局，包括6例（5.5%）死亡和13例（11.8%）AMI事件。24例患者出现次要结局。主要结局的预测因素为植入DES的CISR（HR = 4.36 [1.44 - 12.85]；p = 0.009）和CISR的临床治疗（HR = 10.66 [2.53 - 44.87]；p = 0.001）。植入BMS治疗CISR（HR = 4.08 [1.75 - 9.48]；p = 0.001）和临床治疗（HR = 6.29 [1.35 - 29.38]；p = 0.019）是次要结局的预测因素。