雷帕霉素洗脱支架对糖尿病患者经皮冠状动脉介入治疗的远期影响

目的分析雷帕霉素洗脱支架(SES)对糖尿病患经皮冠状动脉介入治疗后的远期影响。方法采用回顾性研究方法,在1004．例接受冠状动脉内支架术治疗的冠心病患中,84例糖尿病和250例非糖尿病患置入SES;168例糖尿病和502例非糖尿病患置入普通支架。记录并比较一般临床资料、冠状动脉造影及冠状动脉内支架术情况、远期心脏事件发生率和1年无心脏事件生存率。结果随访期间(平均16．2个月),SES组中糖尿病亚组和非糖尿病亚组的远期心脏事件发生率为4．8％比3．6％,P=0．744;1年无心脏事件生存率为95．0％比96．7％,P=0．602,两亚组差异均无统计学意义。但BMS组中,糖尿病亚组的远期心脏事件发生率显高于非糖尿病组(31.0%比21．7％,P=0．015);两亚组的1年无心脏事件生存率分别为74．2％比86．8％(P=0．001)。结论SES能显改善糖尿病患冠状动脉支架术的远期疗效,降低靶病变再狭窄和远期心脏事件的发生率,提高1年无心脏事件生存率。     

两种药物洗脱支架在冠状动脉复杂弥漫病变中的疗效比较

目的比较雷帕霉素洗脱支架(SES)和紫杉醇洗脱支架(PES)对长度≥25mm复杂病变的疗效。方法入选138例患者(男124例,女14例)冠状动脉(冠脉)病变长度≥25mm,接受SES和PES介入治疗,并且在支架术后6个月左右接受冠脉造影随访。结果共147处病变在6个月后随访。其中2型糖尿病患者43例(31·2%),C型病变129处(87·8%)。SES组的支架内再狭窄率(5·9%,17·7%,P=0·023)、支架段再狭窄率(9·4%,21·0%,P=0·048)和支架段晚期腔径丢失[(0·16±0·52)mm比(0·45±0·65)mm,P=0·003)]、支架内晚期腔径丢失[(0·26±0·46)mm比(0·60±0·66)mm,P=0·001)]明显低于PES组。两组之间在随访期间靶病变血管重建率(7·1%比12·9%,P=0·223)差异无统计学意义。结论对于复杂弥漫病变SES在再狭窄率和晚期腔径丢失要优于PES,对于远期预后的影响还需要进一步的观察。SES更适合用于复杂小血管病变。     

Iron status and clinical outcome in patients with coronary artery disease after coronary stenting

BACKGROUND AND AIM: So far, no studies have assessed whether there is an association between iron status and the incidence of major adverse cardiac events or restenosis after coronary stenting. We conducted this study to investigate whether there is an association between body iron status and clinical outcome in patients with coronary artery disease after coronary stenting. METHODS AND RESULTS: The study included 664 patients with coronary artery disease who underwent coronary stent implantation. The soluble transferring receptor/ferritin ratio (sTfR/ferritin ratio) was used as an index of iron status. Patients were divided into three groups according to the tertiles of sTfR/ferritin ratio: lower tertile (<11.9; n = 221), middle tertile (11.9-27.8; n = 221) and upper tertile (>27.8; n = 222). The combined incidence of major adverse cardiac events (death, myocardial infarction and target vessel revascularization) was the primary end point of the study. Patients in the lower tertile of the sTfR/ferritin ratio presented more often with unstable angina or acute myocardial infarction and had longer lesions and higher grade of stenosis than the patients in the middle or upper tertile of the sTfR/ferritin ratio. Angiographic restenosis at 6-month angiography was also evaluated. The cumulative event rate of composite end point of death, myocardial infarction or target vessel revascularization was 27.6% in patients in the lower tertile, 24.4% in patients in the middle tertile and 28.4% in patients in the upper tertile of the sTfR/ferritin ratio (p = 0.68). Restenosis was found in 27.8% (n = 45) in the lower tertile, 25.8% (n = 42) in the middle tertile and 27.5% (n = 38) in the upper tertile of the sTfR/ferritin ratio (p = 0.90). CONCLUSIONS: Our study showed no association between iron status and the incidence of major adverse cardiac events or angiographic coronary restenosis in patients with coronary artery disease after coronary stenting.     

雷帕霉素洗脱支架远期致冠状动脉局部血管瘤样扩张四例报告

目的分析雷帕霉素洗脱支架远期发生冠状动脉局部血管瘤样扩张的特点及原因。方法2004年4—7月接受介入治疗的冠心病患者4例,男3例,女1例,造影显示7支病变血管共置入9个支架,其中前降支置入Cypher select支架5个,回旋支置入Firebird支架2个,Pixel支架1个,右冠状动脉置入Cypher select支架1个。术后口服氯吡格雷75mg／d持续1年。结果4例均成功置入支架,病变血管达TIMI Ⅲ级血流灌注,心绞痛症状消失,无急性／亚急性血栓形成。平均随访（24．8±1．8）个月,无主要心脏不良事件发生。术后12个月冠状动脉造影随访,无支架内再狭窄及新病变出现。停用氯吡格雷,继续门诊随访,病情稳定。4例患者分别于术后16、18、22个月因心绞痛症状复发而再次入院,入院后给予氯吡格雷75mg／d,静脉注射硝酸甘油及皮下注射低分子肝素治疗。冠状动脉造影显示：3例于前降支近段,1例右冠状动脉中段置入Cypher支架的部位冠状动脉呈血管瘤样扩张,扩张处血管直径明显大于临接正常冠状动脉,其他置入支架的血管无病变。术后即刻给予替罗非班（0．1μg·kg^-1·min^-1）连续3天治疗,症状消失。继续随访3—6个月,全部存活,无心绞痛发生。结论雷帕霉素支架远期发生支架贴壁不良,导致血管重构是造成局部血管瘤样扩张的可能原因。     

无聚合物与聚合物紫杉醇涂层支架治疗冠心病的临床对比研究

目的比较无聚合物紫杉醇支架(垠艺)与聚合物紫杉醇涂层支架(TAXUS)用于冠心病患者的安全性及有效性。方法回顾分析兰州大学第一医院心脏中心置入垠艺支架治疗的75例冠心病患者和置入TAXUS支架治疗的59例冠心病患者,对比分析两组患者术后1年内主要不良心脏事件(MACE,包括心源性死亡、再发心绞痛或非致死性心肌梗死、再次靶血管血运重建)发生率、支架内血栓事件的发生率。结果两组除高血压例数外,在基本临床情况(包括年龄、性别、糖尿病、高脂血症、急性心肌梗死、不稳定型心绞痛、急性冠状动脉综合征、稳定型心绞痛)、冠状动脉病变特征(分叉病变、开口病变、三支病变、慢性完全闭塞病变、小病变、长病变、B2+C型病变)及基本介入技术指标(靶血管狭窄程度、病变长度、平均支架管径、平均支架长度)等方面差异均无统计学意义(P均0.05);两组手术操作成功率均为100%,术后随访1年,主要心脏不良事件发生率垠艺组为5.6%,TAXUS组为7.0%,两组比较差异无统计学意义(P0.05);TAXUS组支架内血栓1例,而垠艺组术后无支架内血栓事件发生,但两组比较差异无统计学意义(P0.05)。结论无聚合物紫杉醇支架(垠艺支架)治疗冠心病安全有效,与TAXUS支架相比无明显差异。     

冠状动脉长病变患者置入雷帕霉素洗脱支架和紫杉醇洗脱支架2年临床观察

目的 评价冠状动脉长病变患者成功置入Firebird雷帕霉素洗脱支架和Taxus紫杉醇洗脱支架2年后的有效性和安全性.方法 本研究入选了2004年4月至2006年10月期间,在阜外心血管病医院行择期经皮冠状动脉介入治疗(PCI)的冠状动脉长病变患者826例.入选患者分为Firebird 组(666例)和Taxus组(160例).随访资料包括术后30天、1年和2年的死亡、心肌梗死、血栓、靶病变血运重建和靶血管血运重建.本研究比较了两组间各种临床事件的累积发生率差异.同时通过倾向性评分调整后的Cox比例风险模型比较两组间的2年临床随访结果.结果 两组病变长度[(45.62±15.25) mm比(44.09±13.67)mm]及置入支架长度[(51.22±16.64) mm比(49.63±15.86)mm]相似(P＞0.05).术后2年,Firebird组靶病变血运重建率(3.46％比10.00％,P=0.0005)、靶血管血运重建率(5.42％比11.25％,P=0.008)及MACE发生率(10.99％比20.00％,P=0.002)方面显著低于Taxus组.两组患者术后2年支架肯定或可能血栓形成的发生率差异均无统计学意义.经倾向性评分调整后,与Taxus组相比,应用Firebird支架治疗的患者在术后2年时MACE风险降低(危险比0.622,95％ CI:0.401 ～0.965,P=0.034),而其他临床事件的风险比差异无统计学意义.结论 对于冠状动脉长病变患者而言,使用Firebird雷帕霉素洗脱支架MACE发生率较低,而靶病变血运重建率和靶血管血运重建率方面不劣于Taxus紫杉醇洗脱支架,且风险有下降趋势.     

糖尿病合并冠状动脉慢性完全闭塞性病变患者置入药物洗脱支架的远期预后

目的 评价糖尿病合并冠状动脉慢性完全闭塞性(CTO)病变患者置入药物洗脱支架(DES)的远期临床预后.方法 回顾性分析143例于2006年1月至2007年5月期间连续入院接受经皮冠状动脉介入治疗并置入DES的糖尿病合并CTO病变患者的临床资料,并对患者进行随访.研究终点为主要不良心血管事件,包括死亡、心肌梗死和再次靶病变血管重建.根据随访结果,将患者分为事件组和非事件组.结果 143例患者中,139例完成随访,4例失访,随访(19.8±5.1)个月.长期随访中共发生主要不良心血管事件15例(10.5%),其中死亡3例,心肌梗死1例,再次靶病变血管重建11例.与非事件组比较,事件组的残余狭窄较重[(17.7±1.8)%比(15.4±5.0)%,P=0.001],最终最小管腔直径较小[(2.14±0.22)%比(2.89±0.37)%,P=0.004].Cox回归分析显示,最终最小管腔直径(OR:0.097,95%可信区间:0.013~0.694,P=0.020)为长期随访预后惟一独立危险因素.结论 糖尿病合并CTO患者置人DES安全、有效.最终最小管腔直径可能为长期随访事件的重要预测因子.     

药物洗脱支架置入后血栓形成的原因分析

目的探讨药物洗脱支架置入后血栓形成的发生率以及血栓形成的原因。方法本研究为单中心药物洗脱支架的注册研究,自2001年12月至2005年12月共计3345例冠心病患者接受了药物洗脱支架的治疗,其中使用雷帕霉素洗脱支架（SES）2165例,使用紫杉醇洗脱支架（PES）1180例,完成10个月临床随访为2296例;所有患者均同时口服阿司匹林和氯吡格雷至少9个月。结果3345例患者中9例发生急性血栓形成（O．27％）,其中7例为SES、2例为PES所致（0．32％比0．17％,P=0．637）;7例发生亚急性血栓形成（0．21％）,其中5例为SES、2例为PES所致（0．23％比0．17％,P=0．526）;急性和亚急性血栓发生率为0．48％（16／3345）;13例有晚期血栓形成,5例为SES、8例为PES所致（0．34％比0．95％,P=0．114）;4例晚期血栓形成的主要原因为提前中断抗血小板药物,既往患有心肌梗死病史,心功能差,药物洗脱支架置入后晚期发生血栓致猝死6例。结论支架置入不满意,特别是分叉病变以及支架未能完全覆盖受损伤的病变段是急性和亚急性血栓形成的主要原因;中断抗血小板药物和左心功能不全是晚期血栓形成的主要原因。     

Firebird支架治疗冠心病140例临床观察

观察国产Firebird支架在冠心病患者介入治疗中的临床疗效。方法共140例冠心病患者常规冠状动脉造影后行经皮冠状动脉介入(PCI)治疗,其中64例患者植入Firebird支架,76例患者置入普通支架,术前术后除常规使用阿司匹林和波立维外,同时给予严格的内科强化治疗,术后进行随访。结果冠状动脉造影显示2支以上血管病变占70.56%,一共植入Firebird支架114枚,普通支架105枚,所有患者均获得成功。平均随访(10.2±3.3)个月,其中药物支架组复发心绞痛18例,10例发生心肌梗死;普通组复发心绞痛40例,16例发生心肌梗死。部分患者行冠脉造影复查,Firebird支架组发生再狭窄2例,普通支架组发生再狭窄8例,均进行了靶病变重建术。结论Firebird支架对冠心病患者近期疗效确切,能减少再狭窄的发生。     

Indication of long-term endothelial dysfunction after sirolimus-eluting stent implantation.

AIMS: Endothelial dysfunction has been related both to progression of atherosclerotic disease and to future cardiovascular events. We assessed local epicardial endothelial function 6 months after sirolimus-eluting stent (SES) or bare metal stent (BS) implantation. METHODS AND RESULTS: In 12 patients (seven SES, five BS), endothelium-dependent vasomotion of a coronary segment 15 mm in length, starting 2 mm distal to the stent, was assessed with quantitative coronary angiography immediately after the procedure and at 6 months follow-up, after intracoronary infusion of acetylcholine. Intravascular ultrasound (IVUS) was performed and coronary flow reserve (CFR) assessed in all patients. At follow-up significant vasoconstriction was seen in SES (median 32% diameter reduction from baseline) but not in BS (median 2% reduction) patients after acetylcholine infusion (P=0.03 for SES vs. BS); endothelium-independent vasodilatation to nitrates did not differ significantly between groups (20% SES, 5% BS, P=0.14). IVUS revealed no late unhealed dissections and CFR was comparable between groups (SES 3.1 vs. BS 3.2, n.s.). CONCLUSION: SES implantation may have an adverse effect on local endothelium-dependent vasomotor responses compared with BS implantation at 6 months. Long-term clinical consequences of this observation are still unknown.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

目的 以血管内超声评价雷帕霉素洗脱支架置人术后发生支架内再狭窄及血栓形成的机械性危险因素.方法 对雷帕霉素洗脱支架置入术后发生支架内再狭窄或早期(≤30 d)血栓形成的60例患者(事件组)及无支架内再狭窄和早期血栓形成的34例患者(无事件组)的血管内超声资料进行分析比较.结果 事件组发生支架内再狭窄43例,早期血栓形成17例.与无事件组比较,事件组的最小支架面积(MSA)[(4.6±1.6)mm2比(5.8±1.6)mm2,P＜0.01]、最小支架直径[(2.2±0.5)mm比(2.5±0.4)mm,P＜0.01]和支架扩张率[(69.2±20.7)%比(80.6±17.2)%,P＜0.01]较小、纵向支架对称性较差(2.0±0.6比1.7±0.6,P＜0.05).MSA＜4 mm2(43.3%比14.7%,P＜0.01)和支架扩张率＜60%(40.7%比11.8%,P＜0.01)在事件组较常见.与无事件组比较,事件组的近段残余斑块负倚较大[(49.0±15.5)%比(38.4±17.6)%,P＜0.01].Logistic回归分析显示,MSA(OR:0.7,95%CI:0.5～0.8,P＜0.01)和近段残余斑块负荷(OR:280.7,95%CI:17.2～40 583.6,P＜0.01)是药物洗脱支架发生再狭窄或早期血栓形成的独立预测因素.结论 较小的MSA和较重的近段残余病变易导致雷帕霉素洗脱支架发生支架内冉狭窄及早期血栓形成.     

佐他莫司和西罗莫司支架在老年冠心病患者介入治疗中的对比研究

目的 比较佐他莫司支架和西罗莫司支架治疗老年冠心病的临床效果. 方法回顾性分析2006年8月至2007年5月我院对635例老年冠心病患者连续支架植入治疗的临床资料.其中植入佐他莫司(佐他莫司组)支架334例,西罗莫司(西罗莫司组)支架301例.比较两组治疗成功率、主要心脏不良事件等临床情况,并进行对比分析. 结果两组基线临床特点佐他莫司组高脂血症和左主干病变少于西罗莫司组,佐他莫司组再狭窄病变、支架长度、支架最大释放压和后扩张比率均小于西罗莫司组.两组介入成功率均为100%.主要心脏不良事件发生率与佐他莫司组比较(分别为4.5%(15例)与4.3%(13例)],差异无统计学意义,其中心原性死亡、非致死性心肌梗死和靶血管重建率两组比较,差异无统计学意义.支架内血栓发生率佐他莫司组和西罗莫司组分别为0.3%(1例)和0.7%(2例),差异无统计学意义.早期、晚期支架内血栓发生率两组比较,差异无统计学意义.7个月随访,佐他莫司组和两罗莫司组支架内和血管段再狭窄率[分别为5.9%(4/68)和3.5%(3/36),7.4%(5/65)和4.7%(4/86)]比较,差异无统计学意义.但支架内和血管段的晚期丢失佐他莫司组均大于西罗莫司组,分别为(0.48±0.12)mm与(0.24±0.09)mm和(0.44±0.13)mm与(0.26±0.09)mm,均P< 0.01. 结论7个月随访结果证实,佐他莫司和西罗莫司支架对于老年冠心病患者具有相似的疗效.     

The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus.

AIMS: To investigate the outcome of a real world diabetic patient cohort treated with bare metal stents (BMS), sirolimus-, or paclitaxel-eluting stents (SES and PES, respectively). Due to the different mechanisms of action of both drugs it is currently unknown which device is the best option to treat these high-risk patients. METHODS AND RESULTS: The study compares the 2-year clinical outcome of 708 consecutive diabetic patients (25% insulin treated) treated with either a BMS (n = 252), a SES (n = 206), or a PES (n = 250), as part of the RESEARCH and T-SEARCH registries. Target vessel revascularization was 19.5% in the BMS group, vs. 15.3% in the SES group and 9.7% in the PES group. PES (21.2%), but not SES (28.9%), were superior to BMS (29.7%) in reducing major adverse cardiac events. After propensity analyses, none of the differences remained significant. The incidence of stent thrombosis (ST) was high in both DES groups. CONCLUSION: There was a trend towards a more favourable outcome associated with the use of PES over BMS. There was no significant difference between SES and PES in each of the clinical endpoints, and neither in the NIDDM patients, which are hypothesized to be better-off with PES.     

Randomized trial of paclitaxel- and sirolimus-eluting stents in small coronary vessels.

AIMS: Sirolimus- and paclitaxel-eluting stents effectively reduce restenosis in small coronary vessels. The relative efficacy of these drug-eluting stents in this high-risk subset is not known. METHODS AND RESULTS: A total of 360 patients undergoing percutaneous coronary intervention for de novo lesions in native coronary vessels with a diameter of <2.80 mm received randomly paclitaxel-eluting stents (n=180) or sirolimus-eluting stents (n=180). The primary endpoint was in-stent late luminal loss. Secondary endpoints were angiographic restenosis and need of target lesion revascularization. The study intended to show that the paclitaxel-eluting stent is not inferior to the sirolimus-eluting stent with respect to the primary endpoint. The non-inferiority margin was set at 0.16 mm. Follow-up angiography was performed in 87% of the patients. In-stent late luminal loss in the paclitaxel-eluting stent group was 0.32 mm (upper 95% boundary, 0.42 mm), which was greater than that in the sirolimus-eluting stent group, failing to show the non-inferiority of the paclitaxel-eluting stent to the sirolimus-eluting stent (P>0.99). Angiographic restenosis was found in 19.0% of the lesions in the paclitaxel-eluting stent group and 11.4% of the lesions in the sirolimus-eluting stent group (P=0.047). Target lesion revascularization was performed in 14.7% of the lesions treated with paclitaxel-eluting stents and 6.6% of the lesions treated with sirolimus-eluting stents (P=0.008). CONCLUSION: The paclitaxel-eluting stent is associated with a greater late luminal loss and is less effective in reducing restenosis in small coronary vessels than the sirolimus-eluting stent.     

Comparison of one-year clinical outcomes with paclitaxel-eluting stents versus bare metal stents in everyday practice

BACKGROUND:

In randomized trials, paclitaxel-eluting stents (PES) have been shown to be superior to bare metal stents (BMS) in reducing restenosis. However, the effectiveness of PES in patients treated during routine practice has not been fully established.

METHODS:

A retrospective comparison of PES with BMS in consecutive patients undergoing percutaneous coronary intervention (PCI) from April 2003 to March 2004 was conducted. Outcomes included the composite of death, myocardial infarction and target lesion revascularization (TLR) at one year, as well as stent thrombosis.

RESULTS:

A total of 512 patients were treated with PES, and 722 patients were treated with BMS. Patients in the PES group were more likely to receive stents that were 20 mm in length or longer (52.2% versus 33.3%, P<0.0001), 2.5 mm in diameter or smaller (29.1% versus 12.5%, P<0.0001) and implanted in bifurcation positions (15.4% versus 11.6%, P=0.02). At one year, the composite outcome of death, myocardial infarction and TLR was 6.1% in the PES group compared with 10.8% in the BMS group (P=0.004). The one-year rate of stent thrombosis was 0.59% in the PES group compared with 0.28% in the BMS group (P=0.4).

CONCLUSIONS:

Despite being used in higher-risk lesions, there was a lower rate of major cardiac events at one year in patients treated with PES, primarily driven by the reduction in TLR. Thus, the experience with PES in contemporary practice applied to a broader population appears to be consistent with the results reported in randomized trials.     

复杂冠状动脉病变西罗莫司洗脱支架置入后急性和亚急性支架内血栓形成情况分析

目的评价在真实临床环境下,对于复杂病变置入西罗莫司(雷帕霉素)洗脱支架后支架内急性、亚急性血栓的发生率。方法我院自2002年到2005年3月,连续有796名不同复杂冠状动脉(冠脉)病变的患者完全置入了西罗莫司洗脱支架(sirolimus-eluting stent,SES)。记录患者的一般临床特征和有否急性、亚急性血栓形成;所有患者平均临床随访6~9个月,随访期间对患者进行冠脉造影检查。结果(1)在796例患者中,有8例(1%,8/796)患者发生了经冠脉造影证实的急性/亚急性血栓,其中1例为急性支架内血栓形成,7例为亚急性支架内血栓形成;有1例临床高度怀疑为支架内亚急性血栓形成;(2)上述8例患者中有3例表现为急性ST段抬高的心肌梗死,4例表现为急性非ST段抬高的心肌梗死,1例表现为不稳定型心绞痛;1例高度怀疑支架内血栓形成的患者ECG表现为新发左束支传导阻滞;8例患者中有1例(12.5%,1/8)在30 d内死亡,其余7例患者给予积极治疗后6个月临床随访无不良心脏事件发生,6个月冠脉造影随访支架内没有发生再狭窄;(3)采用多因素逻辑回归分析结果显示分叉病变双支架置入及长病变支架置入是患者术后发生支架内血栓的危险因素,OR值分别为11.2和8.6,95%CI分别为4.1~30.8和1.9~17.2,P<0.001。结论在真实临床环境下,在没有经过严格入选标准筛选的复杂冠脉病变中置入SES支架后30 d内,支架内血栓的发生率在1%(8/796)左右,略高于文献报道的结果。分叉病变双支架及长病变支架是术后支架内发生血栓的高危因素。     

冠状动脉西罗莫司洗脱支架置入后晚期支架内血栓形成分析

目的分析冠状动脉药物洗脱支架置入后晚期支架内血栓形成的临床相关因素。方法回顾性分析2003年7月至2005年1月我院置入西罗莫司洗脱支架的1304例冠心病患者中发生晚期支架内血栓的8例患者的临床资料、冠状动脉病变特点、支架释放情况以及术后的抗血小板治疗等相关因素。结果8例患者平均年龄（51±10）岁、7例为急性冠状动脉综合征患者且伴有多项心血管病危险因素,仅1例患者伴有左室功能不全,无肾功能不全患者;多支冠状动脉病变患者6例且病变较复杂,包括闭塞、分叉、开口和弥漫长病变;支架释放压力平均（1175.37±167．19）kPa（11．60±1．65atm）,全部患者未用高压球囊进行后扩张;双重抗血小板治疗平均时间为（157．5±41．7）d,1例在停用氯吡格雷第7天、2例在服用阿司匹林和氯吡格雷治疗期间、5例停用氯吡格雷6个月后出现支架内血栓,平均血栓发生时间为术后（450．3±344．7）d,5例表现为急性心肌梗死;1例死亡,5例再次置入西罗莫司洗脱支架,术后随访无症状,1例药物治疗。结论发生晚期支架内血栓的冠心病患者多表现为急性冠状动脉综合征、伴有多项心血管病危险因素;多支、复杂冠状动脉病变;支架低压释放,置入后未行后扩张;双重抗血小板治疗时间短。发生晚期支架内血栓患者预后差,死亡率较高,再次置入西罗莫司洗脱支架是安全、有效的。     

冠状动脉内长和短支架及多个支架置入后再狭窄的血管造影随访研究

目的　比较单个短和长支架及多个支架置入的远期血管造影再狭窄发生率。方法　回顾性分析1996年5月至1998年10月在我院接受冠状动脉内支架置入并有血管造影随访的77例病人的临床及血管造影资料。单个短支架组（A组支架长度≤20mm）37例,39支血管;单个长支架组（B组支架长度>20mm）22例,25支血管;多个支架组（C组）18例,18支血管置入39个支架。结果　　病变长度在B和C组明显长于A组［（23.66±12.78)mm和(26.42±13.60)mm与(10.30±4.67)mm,P<0.001］;支架长度C组>B组>A组,P<0.001和0.002。随访时最小管腔开放直径(MLD)和管腔晚期丢失在A和C组间有明显差异,P<0.01和0.02,而在A和B组,B和C组间无统计学差异。三组的再狭窄率分别为28.2%、36%和61.1%,C组明显高于A组（P<0.05）,而B组又高与A组、C组高于B组的趋势,但统计学上无明显差异。Logistic多因素回归分析证实多个支架置入是再狭窄的唯一的独立预测因素（OR=3.29,P<0.05）。结论　多个冠状动脉内支架置入是发生晚期血管再狭窄的唯一独立预测因素;而与单个短支架置入相比,单个长支架置入的再狭窄率也有增高的趋势。     

国产西罗莫司洗脱支架与紫杉醇洗脱支架临床效果比较研究

目的比较国产西罗莫司洗脱支架(FBS)和进口紫杉醇洗脱支架(PES)治疗冠状动脉狭窄的效果。方法选择阜外心血管病医院2004年4月至2005年8月连续接受国产西罗莫司洗脱支架或紫杉醇洗脱支架治疗,并且进行冠状动脉造影随访的228例冠心病患者。排除支架置入失败、位置不理想者。所有的患者术后均接受阿司匹林300mg/d、氯吡格雷75mg/d等规范药物治疗。患者在支架术后6个月后接受冠状动脉造影随访。结果共228例患者(198名男性,30名女性)314个靶病变接受治疗并完成造影随访。其中C型病变占总数的40.1%,平均术前参考血管直径2.80±0.47mm。平均每个病变支架长度25.90±14.54mm。228例患者中118例置入紫杉醇洗脱支架,100例置入西罗莫司洗脱支架。两组在患者基本条件方面,国产西罗莫司洗脱支架组患者年龄大于紫杉醇洗脱支架组,紫杉醇洗脱支架组有更多的2型糖尿患者;在病变基本条件方面,国产西罗莫司洗脱支架组病变更多偏心性病变,其他没有差别。6个月后随访结果国产西罗莫司洗脱支架组的支架再狭窄率明显低于紫杉醇洗脱支架组(5.3%比21.9%,P<0.001)。国产西罗莫司洗脱支架组的靶病变血管重建率(TLR)明显低于紫杉醇洗脱支架组(3.8%比13.1%,P<0.001)。国产西罗莫司洗脱支架组支架内晚期腔径丢失明显小于紫杉醇洗脱支架组(0.18±0.41mm比0.58±0.69mm,P<0.001)。结论国产西罗莫司涂层支架用于临床实践有良好的疗效。     

Segmental vessel wall shear stress and neointimal formation after sirolimus-eluting stent implantation: physiological insights in a porcine coronary model

BACKGROUND: Low vessel-wall shear stress promotes atherosclerosis and restenosis. We conducted serial analysis of vessel-wall shear stress following placement of metal and sirolimus (SRL) stents to determine the relationship between shear stress and neointima. METHODS: Serial quantitative coronary angiography, intracoronary ultrasound (IVUS), and Doppler flow analysis were performed at baseline, immediately poststent, and at 30 and 90 days on 16 stents (metal, n = 8; SRL, n = 8) implanted in the coronary arteries of eight miniswine. Segmental vessel-wall shear stress (dyn/cm2) was calculated at 10 sections within the stent and normalized to the average proximal and distal reference vessel shear stress using IVUS and hyperemic average peak flow velocity. At 90 days, histological analysis was completed to determine vessel-wall morphometry on corresponding sections from each stent. RESULTS: Stent placement resulted in a similar degree of in-stent stenosis (-5% to 25%) and immediate post-in-stent shear stress. At 30 days, the IVUS neointimal cross-sectional area and percentage of area stenosis were significantly less in SRL (1.2+/-0.8 mm2; 12.7+/-8.5%) versus metal stents (2.3+/-0.4 mm2; 28.2+/-3.4%, P < .003). In-stent normalized shear stress was less for SRL (0.93+/-0.07) versus metal (1.07+/-0.08, P = .002) stents. At 90 days, the mean neointimal area was similar for the SRL (2.50+/-0.47 mm2) and metal stents (2.72+/-1.15 mm2). Linear regression documented a negative correlation between poststent shear stress and neointima for metal stents (r = .61, P < .0001). In the SRL stents, however, the post-in-stent shear stress had a positive correlation with neointima (r = .40, P = .0002). CONCLUSIONS: The placement of oversized stents causes alteration of segmental vessel-wall shear stress, which appears to be an important physiological stimulus for neointimal formation, and may influence the pharmacodynamics of SRL-eluting stent in the porcine coronary model.