Cho Jae Young
Department of Cardiovascular Medicine, Regional Cardiocerebrovascular Center, Wonkang University Hospital, Iksan, Korea.
Chonnam Med J. 2017 Sep;53(3):203-210. doi: 10.4068/cmj.2017.53.3.203. Epub 2017 Sep 25.
Although the angiographic rates of in-stent restenosis (ISR) at later months have reduced dramatically with the introduction of drug-eluting stents (DESs), some patients with ISR after implantation of DES present with acute coronary syndrome (ACS). Here, we sought to identify parameters influencing the likelihood of restenosis with ACS presentation after DES implantation. Stented patients (n=3,817) with DESs in the Korea University Anam Hospital percutaneous coronary intervention registry were reviewed retrospectively for inclusion. In this database, 247 age- and sex-matched patients (6.5%) with ISR were allocated to either the Stable ISR group (n=78) or the ACS ISR group (n=73). Predictors of in-stent restenosis were identified with Cox regression analyses. Age (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.02 to 1.27; p=0.026), diabetes (HR, 8.40; 95% CI, 1.30 to 54.1; p=0.025), use of aspirin (HR, 0.003; 95% CI, 0.0001 to 0.63; p=0.03), clopidogrel (HR, 0.005; 95% CI, 0.001 to 0.121; p=0.001), renin-angiotensin system (RAS) blocker (HR, 0.02; 95% CI, 0.003 to 0.14; p<0.001), use of first -generation DES (HR, 0.07; 95% CI, 0.009 to 0.59; p=0.014), and matrix metalloproteinase 2 (MMP-2) levels (HR, 1.120; 95% CI, 1.001 to 1.190; p=0.004) during follow-up angiograms were significant predictors of ISR with ACS presentation during the 3 year follow-up. Age, diabetes, the use of first generation DES, and increased MMP-2 levels were significant predictors of ISR with ACS presentation; moreover, the use of aspirin, clopidogrel, RAS blocker, and the use of second generation DESs prevented ISR with ACS presentation.
尽管随着药物洗脱支架（DES）的引入，后期几个月的支架内再狭窄（ISR）血管造影发生率已大幅降低，但一些DES植入后发生ISR的患者会出现急性冠状动脉综合征（ACS）。在此，我们试图确定影响DES植入后出现ACS的再狭窄可能性的参数。对韩国大学安岩医院经皮冠状动脉介入治疗登记处植入DES的支架置入患者（n = 3817）进行回顾性审查以纳入研究。在该数据库中，247例年龄和性别匹配的ISR患者（6.5%）被分为稳定ISR组（n = 78）或ACS ISR组（n = 73）。通过Cox回归分析确定支架内再狭窄的预测因素。年龄（风险比[HR]，1.14；95%置信区间[CI]，1.02至1.27；p = 0.026）、糖尿病（HR，8.40；95% CI，1.30至54.1；p = 0.025）、阿司匹林的使用（HR，0.003；95% CI，0.0001至0.63；p = 0.03）、氯吡格雷（HR，0.005；95% CI，0.001至0.121；p = 0.001）、肾素 - 血管紧张素系统（RAS）阻滞剂（HR，0.02；95% CI，0.003至0.14；p < 0.001）、第一代DES的使用（HR，0.07；95% CI，0.009至0.59；p = 0.014）以及随访血管造影期间的基质金属蛋白酶2（MMP - 2）水平（HR，1.120；95% CI，1.001至1.190；p = 0.004）是3年随访期间出现ACS的ISR的显著预测因素。年龄、糖尿病、第一代DES的使用以及MMP - 2水平升高是出现ACS的ISR的显著预测因素；此外，阿司匹林、氯吡格雷、RAS阻滞剂的使用以及第二代DES的使用可预防出现ACS的ISR。
