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评价术前实验室参数对冠状动脉慢性完全闭塞病变中药物洗脱支架再狭窄的预测作用。

Evaluation of Preprocedural Laboratory Parameters as Predictors of Drug-Eluting Stent Restenosis in Coronary Chronic Total Occlusion Lesions.

机构信息

Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.

Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China.

出版信息

Angiology. 2019 Mar;70(3):272-278. doi: 10.1177/0003319717752245. Epub 2018 Jan 16.

Abstract

This retrospective, single-center study assessed the prognostic value of several emerging inflammatory markers as predictors of in-stent restenosis (ISR) after drug-eluting stent implantation for coronary chronic total occlusion (CTO) lesions. Consecutive patients (n = 416) who underwent successful percutaneous coronary intervention (PCI) for documented CTO lesions and with follow-up angiography were enrolled. Preprocedural high-sensitivity C-reactive protein (hsCRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) were analyzed. At mean follow-up of 14.4 ± 3.3 months, ISR occurred in 72 patients. Compared with the non-ISR group, preprocedural hsCRP level, PLR, NLR, and RDW were significantly higher in the ISR group. The ISR group also had significantly greater proportions of patients with diabetes and smoking history, lower estimated glomerular filtration rate, higher low-density lipoprotein cholesterol (LDL-C) level and neutrophil count, longer stent length, and higher rate of severe dissection. In multivariate analysis, NLR (odds ratio [OR]: 3.110; 95% confidence interval [CI], 2.102-4.063; < .001) and PLR (OR: 1.029; 95% CI, 1.016-1.143; < .001) were independent predictors of ISR, along with LDL-C level and stent length. In conclusion, higher preprocedural NLR and PLR levels were independent risk factors for the development of ISR in patients who underwent PCI for CTO lesions.

摘要

本回顾性、单中心研究评估了几种新兴炎症标志物作为预测药物洗脱支架置入治疗冠状动脉慢性完全闭塞(CTO)病变后支架内再狭窄(ISR)的预后价值。连续入选了 416 例成功接受经皮冠状动脉介入治疗(PCI)的 CTO 病变且有随访血管造影的患者。分析了术前高敏 C 反应蛋白(hsCRP)、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)和红细胞分布宽度(RDW)。平均随访 14.4 ± 3.3 个月后,72 例患者发生 ISR。与非 ISR 组相比,ISR 组患者术前 hsCRP 水平、PLR、NLR 和 RDW 显著升高。ISR 组患者中患有糖尿病和吸烟史的比例、估算肾小球滤过率、低密度脂蛋白胆固醇(LDL-C)水平和中性粒细胞计数、支架长度和严重夹层发生率显著较高。多变量分析显示,NLR(优势比[OR]:3.110;95%置信区间[CI]:2.102-4.063; <.001)和 PLR(OR:1.029;95% CI:1.016-1.143; <.001)与 LDL-C 水平和支架长度一起是 ISR 的独立预测因子。总之,PCI 治疗 CTO 病变患者术前 NLR 和 PLR 水平较高是 ISR 发展的独立危险因素。

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