急性心肌梗死患者药物支架置入术后支架贴壁不良特征及对预后的影响

目的探讨急性心肌梗死患者置入西罗莫司药物洗脱支架后,支架贴壁不良(ISA)的特征及ISA对临床预后的影响。方法选择197例冠心病(300处病变)患者置入西罗莫司药物洗脱支架。根据临床表现分为急性心肌梗死组(67例,117处病变),不稳定性心绞痛组(73例,99处病变),稳定性心绞痛组(57例,84处病变)。术后1年血管造影时利用血管内超声观察各组患者支架置入处ISA的发生率和特征.根据ISA造声情况又分为贴壁不良患者和非贴壁不良患者.并在复查后1年临床随访主要不良心脏事件(包括靶病变再次血运重建,非致命性心肌梗死,心源性死亡和全因死亡)。结果急性心肌梗死组支架置入后,有17例患者(17处病变.25.4%)在1年随访检查时存在ISA,明显高于不稳定性心绞痛组(7例患者,7处病变,9.6%)和稳定性心绞痛组(4例患者,4处病变,7.0%),P=0.005]。多因素回归分析显示,病变长度(OR=1.068,P=0.037)、急性心肌梗死(OR=2.399,P=0.031)和非糖尿病(OR=6.472.P=0.013)是晚期ISA的独立危险因素。对ISA患者1年临床随访显示,ISA患者与非ISA患者主要心脏不良事件无统计学差异(7.1% vs 2.4%,P=0.203)。结论急性心肌梗死患者置入西罗莫司药物洗脱支架后ISA的发生率较高。支架置入后晚期ISA与临床事件的关系仍需进一步研究。

Late incomplete stent apposition in patients with acute myocardial infarction after sirolimus-eluting stent implantation and its effect on clinical outcome

Objectives To assess late incomplete stent apposition(ISA) in patients with acute myocardial infarction after sirolimus-eluting stent implantation by intravascular ultrasound(IVUS) at 1 year follow-up and to observe effect of ISA on clinical outcome. Methods 197 patients with 300 lesions underwent sirolimus-eluting stents implantation. All patients were divided into acute myocardial infarction(group Ⅰ .57 patients), unstable angina(group Ⅱ ,73 patients) and stable angina (group Ⅲ,67 patients). Quantitative angiography and IVUS analysis were performed at one-year follow-up. Results The occurrence of ISA at follow up was higher in group Ⅰ than in other two groups(25.4% vs 9.6% vs 7.0%, P = 0.005). Independent predictors of ISA at follow-up were lesion length (OR = 1.068,P = 0.037),acute myocardial infarction (OR = 2.399,P = 0.031) and absence of diabetes (OR=6.472,P=0.013). During one-year clinical follow-up,there were no significant differences in major adverse cardiac events between ISA group and non-ISA group. Conclusions ISA is common in patients with acute myocardial infarction after sirolimus-eluting stents implantation. The relationship between ISA and long-term clinical outcomes needs further analysis.