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。

Analysis of acute and subacute stent thrombosis after successful implantation of sirolimus-eluting stent in complex coronary lesions

Objective Current data on stent thrombosis(ST) in drug-eluting stent(DES) have come from randomized trials with strict entry criteria,which limits their generalizability to daily practice.The study sought to determine the real-world incidence of angiographically confirmed and possible stent thrombosis(ST) in an unrestricted population during the first 30 days after sirolimus-eluting stent(SES) implantation.Methods A cohort of consecutive complex patients treated with SES implantation was selected from Sep,2002 to May,2005.A total of 796 subjects entered the study.Results In the first 30 days after SES implantation,1 case had acute stent thrombosis and seven other cases had subacute stent thrombosis.Among these eight patients,ST presented as STEMI in three patients,NSTEMI in four patients and UAP only in one patient.Bifurcation stenting and long lesion stenting were the two significant risk factors(OR was 11.2 and 8.6 respectively,95% CI was 4.1 to 30.8 and 1.9 to 17.2 respectively,P<0.001).One patient died of acute heart failure after the second PCI procedure.Conclusion The ST rate was 1% in complex coronary lesions with unrestricted use of SES.Bifurcation lesion and long lesion stenting are associated with an increased risk of ST.