Meta-analysis of four randomized controlled trials on long-term outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with stenting for multivessel coronary artery disease

To provide a quantitative analysis of long-term clinical outcomes, a meta-analysis of 4 randomized controlled trials of percutaneous coronary intervention (PCI) with stenting versus coronary artery bypass grafting (CABG) for multivessel coronary artery disease was conducted. The search identified 4 randomized controlled trials of PCI with stenting versus CABG that enrolled patients with multivessel coronary artery disease. In conclusion, pooled analysis demonstrated no statistically significant differences in death, cardiac death, Q-wave myocardial infarction, cerebrovascular accidents, and angina pectoris between PCI with stenting and CABG. However, PCI with stenting was associated with a statistically significant increase in subsequent PCI, subsequent CABG, subsequent revascularization (PCI or CABG), and major adverse cardiovascular events relative to CABG.     

Ten-year outcomes after percutaneous coronary intervention of in-stent restenosis in saphenous vein grafts

Background

Only few data is available for long-term outcomes of patients being treated for in-stent restenosis (ISR) in saphenous vein grafts (SVG).

Aims

Thus, the aim of this observational, retrospective study was to close this lack of evidence.

Methods

Between January 2007 and February 2021 a total of 163 patients with 186 ISR lesions located in SVG were treated at two large-volume centers in Munich, Germany. Endpoints of interest were all-cause mortality, target lesion revascularization (TLR) and target vessel myocardial infarction (TVMI). Furthermore, recurrent ISR were assessed. Outcomes are presented as Kaplan–Meier event rates.

Results

Mean age was 72.6 ± 8.6 years, 90.8% were male, 36.8% were diabetics and 42.3% presented an acute coronary syndrome. ISR were treated with DES in 64.0% and with balloon angioplasty (BA) in 36.0%. After 10 years, the rates for all-cause mortality, TVMI and TLR were 58.2%, 15.4%, and 22.6%, respectively. No statistically relevant differences were found between the types of treatment (DES or BA) regarding all-cause mortality (55.7% vs. 63.2%, p = 0.181), TVMI (13.8% vs. 18.6%, p = 0.215) and TLR (21.8% vs. 25.0%, p = 0.764). Median time between first and recurrent ISR was 270.8 days. Recurrent ISR were treated with DES in a comparable proportion as during first ISR (p = 0.075). Independent predictor of TLR is patient age (p = 0.034). The median follow-up duration was 5.1 years (75% CI 2.8; 8.5).

Conclusions

Clinical event rates after intervention of ISR located in SVG are high without statistically relevant differences regarding the type of treatment. However, further studies are needed.     

普罗布考预防老年冠心病患者经皮冠状动脉介入治疗后再狭窄的临床观察

目的　观察抗氧化剂普罗布考预防老年冠心病患者经皮冠状动脉介入治疗 (PCI)后再狭窄的临床效果。方法　 6 2例患者随机分为普罗布考组 (32例 )和对照组 (30例 )。观察PCI前、后及随访 6个月冠状动脉造影、血清氧化指标氧化型低密度脂蛋白、丙二醛和内皮指标一氧化氮、内皮素变化情况。结果　随访 6个月时普罗布考组最小管腔直径和管腔净获得较对照组明显增加 [(2 .2± 0 .7)mmvs (l.4± 0 .3)mm ,P <0 .0 5 ;(1.8± 0 .4 )mmvs(0 .9± 0 .2 )mm ,P <0 .0 1) ],再狭窄率明显下降 (2 0 .2 %vs4 0 .0 % ,P <0 .0 5 ) ;血清氧化型低密度脂蛋白和丙二醛较对照组明显减少 [(0 .381± 0 .0 8)mg Lvs(0 .70 5± 0 .16 )mg L ,P <0 .0 1;(6 .2 0± 0 .5 7)nmol Lvs(l8.6 2± 2 .13)nmol L ,P <0 .0 1) ]。结论　抗氧化剂普罗布考可以降低PCI后 6个月冠状动脉再狭窄的发生率。     

冠状动脉介入治疗中阿昔单抗两种给药途径治疗效果比较的meta分析

目的:比较冠状动脉介入治疗（PCI）中冠状动脉内和静脉内使用阿昔单抗的治疗效果。方法: 计算机检索 PubMed、 EMbase、 Cochrane图书馆、 中国生物医学文献光盘数据等数据库,系统性搜索已发表的相关临床研究,并对纳入的研究进行质量评价,对相关结果进行meta分析。共纳入6个随机对照临床研究,共1 138例患者,其中试验组580例（冠状动脉内运用阿昔单抗组）,对照组558 例（静脉内运用阿昔单抗组）。纳入患者均为急性ST段抬高型心肌梗死。结果: 冠状动脉内运用阿昔单抗组仅在心肌梗死溶栓后Ⅲ级血流所占比例优于静脉内运用阿昔单抗组［RR=1.06,95%CI（1.01,1.12）,P=0.02］。而在病死率［RR=0.48,95%CI（0.23,1.02）,P=0.06］、靶血管血运重建［RR=0.55,95%CI（0.30,0.99）,P=0.05］,以及出血事件发生率［RR=0.88,95%CI（0.63,1.23）,P=0.44］,两组没有统计学意义上的差异。结论:与静脉内使用阿昔单抗组相比,冠状动脉内使用阿昔单抗改善了急性ST段抬高型心肌梗死患者的心肌灌注,但并未降低其病死率、靶血管血运重建及出血事件发生率。     

Meta-analysis comparing bivalirudin versus heparin monotherapy on ischemic and bleeding outcomes after percutaneous coronary intervention

With femoral access, bivalirudin decreases risks of major bleeding after percutaneous coronary intervention (PCI) and provides better net clinical benefit compared to unfractionated heparin (UFH) plus planned glycoprotein IIb/IIIa inhibitors. Whether this benefit exists compared to UFH monotherapy is less clear. We performed a systematic review and meta-analysis to compare outcomes in patients undergoing transfemoral PCI with UFH or bivalirudin. Randomized trials (n = 3) and observational studies (n = 13) comparing bivalirudin to UFH monotherapy were reviewed. Primary outcomes were 30-day rates of major adverse cardiovascular events (MACEs) including death, myocardial infarction (MI), urgent revascularization, as well as all-cause mortality, MI, major bleeding, and blood transfusion. We collected data from 16 studies involving 32,492 patients undergoing PCI. Most observational studies were performed in the United States, whereas all randomized trials were done in Europe. Compared to UFH monotherapy, bivalirudin was associated with similar risk of MACEs (odds ratios [OR] 0.92, 95% confidence interval [CI] 0.75 to 1.12), a substantial 45% relative decrease in major bleeding (OR 0.55, 95% CI 0.43 to 0.72), and a trend in the decrease of transfusion (OR 0.87, 95% CI 0.70 to 1.08). A decrease in mortality was seen in observational studies (OR 0.62, 95% CI 0.45 to 0.85) but remained inconclusive in randomized trials (OR 0.63, 95% CI 0.20 to 2.01). MI rate was similar with the 2 anticoagulants. In conclusion, in patients undergoing transfemoral PCI, the benefit of bivalirudin over UFH monotherapy is driven by a significant decrease in major bleeding with similar rates of MACE. As PCI practice moves toward other bleeding-avoidance strategies such as the radial approach, future studies should focus on the interaction between anticoagulant strategy and access-site choice.     

葡萄糖与极化液对经皮冠状动脉介入治疗术后心肌损伤的随机对照研究

目的比较葡萄糖与极化液对减少经皮冠状动脉介入治疗（PCI）术后心肌损伤的不同作用。方法选择接受PCI治疗的冠心病患者100例,随机分为试验组和对照组,各50例。试验组在常规治疗的基础上于PCI术前2～4h给予10％葡萄糖溶液500ml,对照组则给予极化液（10％葡萄糖溶液500m1＋10％氯化钾溶液10ml＋胰岛素12U）。所有患者术前及术后次日检测磷酸激酶同工酶（CK—MB）和肌钙蛋白I（cTnI）浓度。结果试验组和对照组基线临床资料差异无统计学意义（P〉0．05）。试验组PCI术前快速血糖水平显著高于对照组[（11．9±3．6）w（5．3±3．7）mmol／L,P〈0．001];试验组PCI术后快速血糖水平亦显著高于对照组[（8．8±4．2）VS（5．1±3．9）mmol／L,P〈0．001]。试验组患者PCI术前快速血糖水平无1例≤5．0mmol／L,而对照组患者有7例（14．0％）出现快速血糖水平≤5．0mmol／L。两组患者PCI术后CK—MB和cTnI均显著升高,且对照组CK—MB和cTnI升高幅度更显著,对照组CK—MB和cTnI升高1～3倍者及〉3倍者的比例更高（均P〈0．05）。结论冠心病患者PCI术前应用葡萄糖较极化液可显著减少PCI术后心肌损伤。     

A meta-analysis of randomized trials of rescue percutaneous coronary intervention after failed fibrinolysis

Previous trials have suggested clinical benefit with rescue percutaneous coronary intervention (PCI) after failed fibrinolysis, but more recent, larger studies are conflicting. Therefore, we designed a meta-analysis to determine whether rescue PCI improves outcomes compared with conservative therapy in the setting of early failure of fibrinolysis. We searched MEDLINE for randomized trials by using the Medical Subject Heading terms "angioplasty," "myocardial infarction," "thrombolytic therapy," and "fibrinolysis." The inclusion criteria were (1) acute ST-elevation myocardial infarction initially treated with fibrinolytics, (2) randomization of patients with failed fibrinolysis to immediate PCI or conservative therapy, and (3) available short-term clinical outcome data. The primary end point was short-term mortality and secondary end points were thromboembolic stroke and heart failure. Numbers of events were tabulated for each trial and risk ratios (RRs) were computed. Five trials were included for analysis. The pooled RR estimates showed a 36% decrease in the risk of death in the rescue arm (RR 0.64, 95% confidence interval 0.41 to 1.00, p=0.048) and a marginally significant 28% decrease in the risk of heart failure (RR 0.72, 95% confidence interval 0.51 to 1.01, p=0.06). We also found a marginally increased risk of thromboembolic stroke in the rescue arm (RR 3.61, 95% confidence interval 0.91 to 14.27, p=0.07). In conclusion, rescue PCI in the setting of early fibrinolytic failure improves mortality, but this is tempered by a possible increase in the risk of thromboembolic stroke.     

Smoking status on outcomes after percutaneous coronary intervention

Background:

The effect of smoking on prognosis among patients undergoing percutaneous coronary intervention (PCI) is controversial, and data on the importance of smoking cessation or reductions were lacking.

Hypothesis:

Smoking cessation or reductions could reduce the risk of adverse outcomes in patient after PCI.

Methods:

There were 19 506 consecutive patients who had undergone successful PCI between April 2004 and January 2010 followed. Extensive data, including self‐reported smoking habits, were obtained at baseline and during follow‐up.

Results:

Compared with post‐PCI quitters and persistent smokers, the nonsmokers and pre‐PCI quitters were older and had a higher prevalence of comorbid factors such as hypertension and impaired left ventricle function. The adjusted hazard ratios for mortality were 2.52 (95% confidence interval [CI]: 1.92–3.30) for nonsmokers, 0.52 (95% CI: 0.32–0.84) for pre‐PCI quitters, and 0.11 (95% CI: 0.06–0.22) for post‐PCI quitters, compared to persistent smokers. With respect to additional revascularizations, a higher risk was observed among the quitters (1.70 [95% CI: 1.40–2.08] for pre‐PCI quitters and 1.59 [95% CI: 1.36–1.85] for post‐PCI quitters) as well as the nonsmokers (1.40 [95% CI: 1.20–1.64]). Among persistent smokers, each reduction of 5 cigarettes/day was associated with a 72% decline in mortality risk (P < 0.001) but did not reach statistical significant for repeated revascularizations (0.80 [95% CI: 0.46–1.37], P = 0.4132).

Conclusions:

Despite a higher risk of revascularization, the cessation of smoking either before or after PCI is beneficial in all‐cause mortality. The apparent smoker's paradox may be explained by the differences in baseline risk or the reduced sensitivity to adverse outcomes as well as the reluctance to seek medical help among smokers. This study received an unrestricted grant from Pfizer Investment Co., China. The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

Meta-analysis of randomized controlled trials of intracoronary versus intravenous administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention for acute coronary syndrome

It is unclear whether intracoronary (IC) bolus administration of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI) in patients with acute coronary syndromes is superior to intravenous (IV) administration. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effects of IC and IV administrations of GPIs in patients with acute coronary syndromes. We systematically searched the Cochrane Library, EMBASE, and MEDLINE databases for RCTs comparing IC to IV administration of GPIs (abciximab, eptifibatide, tirofiban) during PCI. Data were pooled and stratified into short (1 month to 3 months) and mid-/long-term (≥6 months) follow-up durations. Ten RCTs involving 1,590 patients met our inclusion criteria. Compared to the IV group the IC group was more likely to have complete perfusion (Thrombolysis In Myocardial Infarction grade 3 flow) after PCI (risk ratio [RR] 1.08, 95% confidence interval [CI] 1.02 to 1.15). IC administration was associated with similar bleeding rates as IV (RR 0.92, 95% CI 0.68 to 1.24) but with a significant decrease in short-term target vessel revascularization (RR 0.54, 95% CI 0.30 to 0.96). IC administration was also associated with a significant decrease in short-term mortality (RR 0.45, 95% CI 0.23 to 0.90) but this decrease was no longer significant in mid-/long-term RCTs. In conclusion, compared to IV administration IC administration of GPIs has favorable effects on Thrombolysis In Myocardial Infarction flow, target vessel revascularization, and short-term mortality after PCI, with no difference in rates of bleeding. Data regarding mid-/long-term outcomes were limited and inconclusive. Large RCTs with longer follow-up are required to determine long-term safety and efficacy.     

Plasma fibrinogen levels and restenosis after primary percutaneous coronary intervention

Plasma fibrinogen levels influence restenosis following elective percutaneous coronary intervention (PCI) for stable angina. It is unknown whether the same is true in the setting of primary PCI. The aim of the study was therefore to assess whether fibrinogen levels were associated to 6-month in-stent restenosis (ISR) in STEMI patients undergoing successful primary PCI. From January 2003 to October 2004, 267 patients were admitted to our Institution for STEMI and treated by primary PCI. Of these, 171 patients met the inclusion criteria and were enrolled in our study. Fibrinogen levels were assessed at admission, 12 h, 24 h, 48 h, 72 h following PCI and at discharge. Six-month angiographic follow-up was 100% complete. Subjects with 6-month ISR showed higher fibrinogen levels than patients without ISR. Patients in the upper fibrinogen tertile showed a higher 6-month incidence of symptoms and/or inducible myocardial ischemia (27.1% vs. 7.1%, P = 0.006) and a larger late lumen loss (1.3 ± 0.8 vs. 1.0 ± 0.9 mm, P = 0.049). Logistic regression analysis demonstrated a significant and independent association between fibrinogen levels and ISR. Our study suggests that increased plasma fibrinogen levels are related to ISR in STEMI patients undergoing primary PCI. Larger studies are warranted to assess the prognostic value of fibrinogen over harder end-points.     

Bivalirudin versus heparin for percutaneous coronary intervention: an updated meta-analysis of randomized controlled trials

AimsGiven controversy over anticoagulation regimens for percutaneous coronary intervention (PCI), we performed an updated meta-analysis of randomized controlled trials (RCTs) to compare bivalirudin versus heparin.Methods and resultsMedline/Pubmed and Cochrane CENTRAL were searched for all RCTs comparing bivalirudin with provisional glycoprotein IIb/IIIa inhibitor (GPI) use versus heparin with provisional or routine GPI use for PCI. Pooled estimates of 30 day outcomes, presented as risk ratios (RR) [95% confidence intervals], were generated with random-effect models. Our analysis included 14 studies with 30,446 patients that were randomized to bivalirudin with provisional GPI use (n = 14,869) versus heparin with provisional (n = 6451) or routine GPI use (n = 9126). There was no significant difference between anticoagulation with bivalirudin compared with heparin for death (RR 0.95 [0.78–1.14]) or myocardial infarction (RR 1.10 [0.97–1.25]). Early stent thrombosis was significantly greater with bivalirudin compared with heparin (RR 1.61 [1.18–2.20], p = 0.003), especially in patients undergoing primary PCI (2.15 [1.15–4.03], p = 0.02). However, bivalirudin reduced the risk of major bleeding (RR 0.59 [0.51–0.70], p < 0.0001) and TIMI major bleeding (RR 0.59 [0.48–0.72], p < 0.0001) compared with heparin. Meta-regression analysis demonstrated that bleeding risk with use of heparin significantly increases with increasing GPI use (p = 0.02).ConclusionMeta-analysis of 14 RCTs with 30,446 patients demonstrated that bivalirudin is associated with higher risk of stent thrombosis but lower risk of major bleeding compared with heparin.     

A meta-analysis of randomized controlled trials appraising the efficacy and safety of cilostazol after coronary artery stent implantation

Objectives: To evaluate the impact of cilostazol on the angiographic and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) with stents and treated with aspirin and thienopyridine. Methods: A total of 11 randomized controlled trials including 8,525 patients comparing triple antiplatelet therapy (aspirin, thienopyridine and cilostazol) with standard dual antiplatelet therapy were included in the analysis. The primary end points were in-segment late loss and angiographic restenosis at angiographic follow-up. Secondary end points included mortality, stent thrombosis, target lesion revascularization (TLR) and major adverse cardiac events (MACE). Results: Triple antiplatelet therapy was associated with a significant reduction in late loss [weighted mean difference 0.14, 95% confidence interval (CI) 0.08-0.20; p < 0.001] and angiographic restenosis [odds ratio (OR) 0.58, 95% CI 0.48-0.71; p < 0.001]. Addition of cilostazol to dual antiplatelet therapy was associated with a significant reduction in TLR (OR 0.56, 95% CI 0.41-0.77; p < 0.001) and MACE (OR 0.72, 95% CI 0.60-0.86; p < 0.001) with no differences in mortality (p = 0.29), stent thrombosis (p = 0.60) or bleeding episodes (p = 0.77). Conclusions: Cilostazol in addition to dual antiplatelet therapy appears to be effective in reducing the risk of restenosis and repeat revascularization after PCI without any significant benefits for mortality or stent thrombosis.     

Angiographic patterns of drug-eluting stent restenosis and one-year outcomes after treatment with repeated percutaneous coronary intervention

Patterns of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation and outcomes after treatment have not been studied systematically in all comers. We compared patterns of ISR and outcomes of repeated percutaneous coronary intervention in consecutive patients with DES-ISR. A total of 137 patients with 182 lesions underwent repeated percutaneous coronary intervention for DES-ISR at Columbia University Medical Center from August 2004 to April 2006. DES-ISR was treated with repeated DES placement in 84% of patients and balloon angioplasty in 16%. There was 1 stent thrombosis at 30 days, and at 1 year, major adverse cardiac events occurred in 10% of patients, driven primarily by an 8% rate of target-lesion revascularization. After exclusion of 12 patients with multiple ISR lesions, data were further analyzed from 125 patients with 152 DES-ISR lesions, of which 118 were originally treated with sirolimus-eluting stents and 34 were treated with paclitaxel-eluting stents (PES-ISR). Baseline features were well matched between the 2 groups, except that patients with PES-ISR were older. A focal pattern of ISR was observed in 69.5% of patients overall. However, patients originally treated with a PES had a significantly higher frequency of diffuse-intrastent ISR in comparison with sirolimus-eluting stent ISR (30.3% vs 13.6%, p = 0.03). In conclusion, the pattern of ISR in most DES-ISR in this unselected patient population was focal, with higher rates of diffuse intrastent restenosis seen with PES-ISR. Treatment with either repeated DES implantation or balloon angioplasty for DES-ISR was safe and associated with low overall rates of target-lesion revascularization and major adverse cardiac events at 1 year.     

Meta-analysis of prospective randomized controlled trials comparing intracoronary versus intravenous abciximab in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Abciximab is a glycoprotein IIb/IIIa receptor inhibitor that has been shown to improve outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention (pPCI). An earlier study reported better efficacy with intracoronary (IC) compared to intravenous (IV) administration, but this finding has not been duplicated in other studies, thus leaving a great deal of uncertainty as to the most efficacious route of administration. To investigate if IC abciximab compared to IV administration decreases mortality and major adverse cardiac events in patients with ST-segment elevation myocardial infarction who undergo pPCI, a meta-analysis was performed consisting only of prospective randomized controlled trials. Subgroup analysis was performed to investigate the source of difference in efficacy between the 2 strategies. A meta-analysis of 4 trials including 1,148 subjects revealed that IC abciximab significantly reduced mortality compared to IV administration (1.5% vs 3.6%, odds ratio 0.44, 95% confidence interval 0.20 to 0.95, p = 0.04). Major adverse cardiac events were also reduced in a subgroup in which <30% of patients received aspiration thrombectomy (6.1% vs 16.2%, odds ratio 0.33, 95% confidence interval 0.18 to 0.61, p = 0.0004). In conclusion, the totality of the data available from relatively small but high-quality studies shows a significant mortality reduction associated using IC abciximab for pPCI compared to IV abciximab. IC abciximab in the setting of pPCI for ST-segment elevation myocardial infarction may be beneficial for patients with higher risk profiles.     

Smoking and health outcomes after percutaneous coronary intervention

Background This study was designed to describe the impact of smoking on health status and mortality after percutaneous coronary intervention (PCI). Methods A cohort of 271 consecutive PCI patients at the Mid-America Heart Institute of St Luke's Hospital in Kansas City, Mo, were observed in a prospective, observational study. Surveys that included health status assessments were administered at baseline and at 6 and 12 months after intervention. Primary outcome was health status as measured by the Short Form-12 (SF-12) and the Seattle Angina Questionnaire (SAQ). Results Risk-adjusted statistical models demonstrated that, across a number of health-related quality of life domains, patients who were current smokers had poorer health status outcomes than other patients after revascularization. For instance, patients who had never smoked (P < .001) and patients who were former smokers (P < .001) scored significantly higher than patients who were current smokers on the physical component score of the SF-12, which indicated a better sense of overall physical function. Similarly, patients who had never smoked and patients who were former smokers reported significantly fewer physical limitations, less angina, and a higher quality of life on the SAQ than patients who were current smokers. Smoking status was unrelated to mortality rate in the 12 months after revascularization. Conclusions Smoking substantially limits the potential health status benefits of PCI. (Am Heart J 2003;145:652-7.)     

Comparison of ticlopidine and cilostazol for the prevention of restenosis after percutaneous transluminal coronary angioplasty

Prevention of restenosis after percutaneous transluminal coronary angioplasty (PTCA) continues to be a significant problem. Recent controlled studies have demonstrated that cilostazol suppresses restenosis after PTCA. The effects of ticlopidine, another antiplatelet agent, were compared in terms of outcomes of patients randomized for treatment with the two drugs after PTCA. A total of 35 patients (47 lesions) were assigned prospectively and randomly to ticlopidine (17 patients, 24 lesions) and cilostazol (18 patients, 23 lesions) groups. Minimal luminal diameter (MLD) and percentage of stenosis to reference diameter were estimated before PTCA, just after the procedure and after 4 months follow-up. All patients underwent 4 months angiographic follow-up, at the end of which MLD was 2.03+/-0.71 mm in the ticlopidine group and 2.05+/-0.68 mm in the cilostazol group (p = 0.95), and the percentage of stenosis to reference diameter was 31.4+/-16.7% and 30.0+/-17.0%, respectively (p = 0.78). The restenosis rate was 12.5% in the ticlopidine group and 17.4% in the cilostazol group (p = 0.69), relatively low as compared to the 20% to 30% reported in previous studies. Adverse drug reactions during the follow-up period were observed in two of the ticlopidine group and none of the cilostazol group. We conclude that both ticlopidine and cilostazol are effective for the prevention of restenosis after PTCA, however the former may be associated with slight side effects.     

血浆总胆红素浓度与经皮冠状动脉介入治疗后支架内再狭窄的研究

目的探讨冠状动脉粥样硬化性心脏病（冠心病）患者血浆总胆红素（total bilirubin,TBIL）浓度与冠状动脉支架内再狭窄的关系。方法选择241例接受经皮冠状动脉介入（percotaneous coronary intervention,PCI）治疗以及术后1年内再次接受冠状动脉造影（CAG）检查的患者,根据影像结果分为再狭窄组和非再狭窄组,分别在PCI治疗前、出院前及复查冠状动脉造影前测定血浆TBIL浓度。比较分析两组相应的TBIL浓度。结果再狭窄组PCI治疗前、出院前及复查冠状动脉造影前的TBIL浓度与非再狭窄组分别进行比较,差异有统计学意义（P〈0．05）。多因素Logistic回归分析结果显示,血浆TBIL浓度是预测再狭窄的独立危险因子（P〈0．05）。结论血浆TBIL浓度与PCI治疗后再狭窄密切相关．是预测PCI治疗后再狭窄的独立预测因子。