[Palmaz-Schatz 血管内支架冠状动脉植入术后亚急性血栓形成的短期结果及血管造影预测因素]

[The short-term results and angiographic predictors of subacute thrombosis in the coronary implantation of the Palmaz-Schatz endoprosthesis].

作者信息

Díaz L, Fajadet J, Cassagneau B, Robert G, Marco J

机构信息

Unidad de Cardiología Intervencionista, Clinique Pasteur, Toulouse, Francia.

出版信息

Rev Esp Cardiol. 1994 Nov;47(11):747-53.

PMID:7800905

Abstract

INTRODUCTION AND OBJECTIVES

Intracoronary stenting has been proposed as an adjunct to balloon angioplasty in order to improve the immediate and long-term results. The purpose of this study was evaluate the short-term results, subacute closure rate and to try to identify angiographic predictors of subacute thrombotic after Palmaz-Schatz stent implantation.

METHODS

Through a prospective registry, we have evaluated in 500 patients the safety and efficacy of Palmaz-Schatz stent implantation (580 in total) in coronary arteries and saphenous vein grafts. The identification of clinic and angiographic predictors of subacute closure have been evaluated with the assistance of a BMDP statistical software using an univariate and multivariate statistical analysis (logistic regression). The determination of diameter and stenosis has been achieved by electronic caliper.

RESULTS

The stent was implanted successfully in 98.6% of the patients. There was no abrupt closure (< or = 1 day), however 36 patients (7.2%) developed subacute thrombotic closure (among 2nd-21st day after stenting). The major complications were: death 9 patients (1.8%), bypass surgery 7 patients (1.4%) and myocardial infarction 21 patients (4.2%). The predictors of subacute thrombotic closure through univariate statistical were: stenting for bail-out (S.T.: 27%; p < or = 0.0001), multiple stenting (S.T.: 24.1%; p < or = 0.0001), final diameter stent < or = 3.25 mm (S.T.: 12.6%; p < or = 0.013), and left ventricular ejection fraction < or = 45% (S.T.: 15.7%; p < or = 0.022). We showed with logistic regression that final diameter stent < or = 3.25 mm; p < or = 0.0030, left ventricular ejection fraction < or = 45%; p < or = 0.0012, stenting for bail-out; p < or = 0.0195 and multiple stenting; p < or = 0.0252, were predictors of subacute thrombotic closure.

CONCLUSIONS

The Palmaz-Schatz coronary stenting will preferably realize in those arteries bigger than 3.25 mm and left ventricular ejection fraction > 45%, showing multiple stenting and stenting for bail-out greater subacute thrombotic closure rate.

摘要

引言与目的

冠状动脉内支架置入术已被提议作为球囊血管成形术的辅助手段，以改善即刻和长期疗效。本研究的目的是评估短期疗效、亚急性闭塞率，并试图确定Palmaz-Schatz支架植入术后亚急性血栓形成的血管造影预测因素。

方法

通过前瞻性登记，我们评估了500例患者（共植入580枚支架）冠状动脉和大隐静脉移植血管中Palmaz-Schatz支架植入术的安全性和有效性。在BMDP统计软件的辅助下，使用单变量和多变量统计分析（逻辑回归）评估亚急性闭塞的临床和血管造影预测因素。直径和狭窄程度的测定通过电子卡尺完成。

结果

98.6%的患者支架成功植入。无急性闭塞（≤1天），然而36例患者（7.2%）发生亚急性血栓性闭塞（在支架置入后第2至21天）。主要并发症为：死亡9例（1.8%），搭桥手术7例（1.4%），心肌梗死21例（4.2%）。单变量统计分析显示亚急性血栓性闭塞的预测因素为：补救性支架置入（亚急性血栓性闭塞率：27%；p≤0.0001）、多个支架置入（亚急性血栓性闭塞率：24.1%；p≤0.0001）、最终支架直径≤3.25mm（亚急性血栓性闭塞率：12.6%；p≤0.013），以及左心室射血分数≤45%（亚急性血栓性闭塞率：15.7%；p≤0.022）。逻辑回归分析表明，最终支架直径≤3.25mm；p≤0.0030，左心室射血分数≤45%；p≤0.0012，补救性支架置入；p≤0.0195，以及多个支架置入；p≤0.0252，是亚急性血栓性闭塞的预测因素。