Clinical and Research Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Beijing Fuxing Hospital, Capital Medical University, XiCheng District, Beijing, China.
BMC Cardiovasc Disord. 2021 Sep 15;21(1):438. doi: 10.1186/s12872-021-02245-6.
The risk factors of in-stent restenosis (ISR) among coronary artery disease (CAD) patients with syphilis after percutaneous coronary intervention (PCI) are not fully understood. Therefore, this study aimed to elucidate not only the risk factors of ISR among CAD patients with syphilis after performing PCI, but also the population attributable risk percentage (PAR%), which is used to quantify the proportion of ISR that could be eliminated if particular risk factors are not present.
Evaluation of the prevalence, risk factors, and their PAR% for ISR among CAD patients with syphilis undergoing PCI was conducted retrospectively at Beijing Ditan Hospital. CAD patients with syphilis underwent PCI from August 2010 to August 2019 and received a diagnosis, coronary angiography, PCI, and periodical follow-up. The clinical, laboratory, and imaging data were reviewed and summarised anonymously from electronic medical records. The chi-square or Fisher exact test was used in data analysis.
Among 114 CAD patients with syphilis undergoing PCI, ISR occurred in 18 patients (15.78%). The multivariate Cox regression model indicated that average stent length ≥ 35 mm (adjusted hazard ratio [HR] = 4.47, 95% confidence interval [CI] = 1.30-15.44, p = 0.018) and titres of the toluidine red unheated serum test (TRUST) > 1:16 (adjusted HR = 3.72, 95% CI = 1.22-11.36, p = 0.021) were associated with an increased risk of ISR, while successful antisyphilitic treatment (adjusted HR = 0.12, 95% CI = 0.02-0.95, p = 0.045) was protective predictor of ISR among these patients. The PAR% values of particular risk factors associated with ISR including average stent length ≥ 35 mm, titres of TRUST > 1:16, and successful antisyphilitic treatment were 12.2%, 24.0%, and -39.6%, respectively, among these patients.
Preventing the occurrence of ISR among CAD patients with syphilis undergoing PCI requires clinical intervention. Our results indicated that carefully evaluating the length of the vessel lesion to determine whether the stent length is < 35 mm, prioritising the clinical intervention for titres of TRUST > 1:16, and providing successful antisyphilitic treatment could reduce the risk of ISR occurrence.
梅毒感染经皮冠状动脉介入治疗（PCI）后冠心病（CAD）患者的支架内再狭窄（ISR）的风险因素尚不完全清楚。因此，本研究旨在阐明梅毒感染 CAD 患者 PCI 后 ISR 的风险因素，以及人群归因风险百分比（PAR%），该百分比用于量化如果不存在特定风险因素，ISR 可消除的比例。
在北京地坛医院对梅毒感染 CAD 患者 PCI 后 ISR 的患病率、风险因素及其 PAR%进行回顾性评估。2010 年 8 月至 2019 年 8 月，梅毒感染 CAD 患者接受 PCI 治疗，并接受诊断、冠状动脉造影、PCI 和定期随访。从电子病历中匿名回顾和总结临床、实验室和影像学数据。数据分析采用卡方检验或 Fisher 确切概率法。
在 114 例梅毒感染 CAD 患者接受 PCI 中，18 例（15.78%）发生 ISR。多变量 Cox 回归模型表明，平均支架长度≥35mm（校正风险比[HR] = 4.47，95%置信区间[CI] = 1.30-15.44，p = 0.018）和甲苯胺红不加热血清试验（TRUST）滴度>1：16（校正 HR = 3.72，95% CI = 1.22-11.36，p = 0.021）与 ISR 风险增加相关，而成功的抗梅毒治疗（校正 HR = 0.12，95% CI = 0.02-0.95，p = 0.045）是这些患者 ISR 的保护性预测因子。与平均支架长度≥35mm、TRUST 滴度>1：16 和成功抗梅毒治疗相关的特定风险因素的 PAR%值分别为 12.2%、24.0%和-39.6%。
预防梅毒感染 CAD 患者 PCI 后 ISR 的发生需要临床干预。我们的结果表明，仔细评估血管病变的长度以确定支架长度是否<35mm，优先考虑 TRUST 滴度>1：16 的临床干预，并提供成功的抗梅毒治疗，可以降低 ISR 发生的风险。
