冠状动脉雷帕霉素涂层支架植入术后支架内再狭窄临床预测因素探讨

目的 分析氧化型低密度脂蛋白(ox-LDL)、同型半胱氨酸(Hcy)与冠状动脉支架内再狭窄(ISR)的关系,探讨雷帕霉素涂层支架植入后ISR临床预测因素.方法 入选400例冠状动脉雷帕霉素涂层支架植入患者,根据冠状动脉复查造影结果分为ISR组和无ISR组.术前及复查造影时检测血浆ox-LDL、Hcy水平.采用多元Logistic回归分析评价ISR相关临床参数、血管造影特征及手术相关因素.结果 ISR组48例,无ISR组352例,临床ISR发生率为13.6％.与无ISR组比较,ISR组患者支架植入术前、冠状动脉复查造影时血浆ox-LDL、Hcy水平明显升高,差异均有统计学意义(P＜0.05).多元Logistic回归分析结果显示,伴高血压病、伴糖尿病、Hcy 、ox-LDL、服用他汀类药物、吸烟、冠状动脉开口病变、冠状动脉分叉病变、慢性完全闭塞病变、参考血管直径、术前血管狭窄程度、植入支架直径、植入支架长度为ISR独立相关因素.结论 冠状动脉雷帕霉素涂层支架植入后ISR并不少见.伴高血压、伴糖尿病、Hcy、ox-LDL、吸烟、冠状动脉开口病变、冠状动脉分叉病变、慢性完全闭塞病变、术前血管狭窄程度、参考血管直径、植入支架直径、植入支架长度为ISR独立相关因素.长期规律服用他汀类药物可降低ISR风险.

Investigation of the clinical predictors of in-stent restenosis after rapamycin-eluting coronary stent implantation

Objective To analyze the relationship of oxidized low density lipoprotein (ox-LDL) and homocysteine (Hcy) with coronary in-stent restenosis (ISR),and to discuss the clinical predictors of ISR after rapamycin-eluting coronary stent implantation.Methods A total of 400 patients,who had received rapamycin-eluting coronary stent implantation,were enrolled in this study.According to follow-up coronary angiography findings,the patients were divided into ISR group and non-ISR group.Plasma ox-LDL and Hcy levels were tested before percutaneous coronary intervention (PCI) as well as at the time of follow-up coronary angiography.Multivariate logistic regression analysis was used to evaluate ISR-related clinical parameters,angiographic features and surgical factors.Results ISR group had 48 patients and non-ISR group had 352 patients,the clinical incidence rate of ISR was 13.6％.Compared with non-ISR group,the plasma ox-LDL and Hcy levels tested before stent implantation and at the time of follow-up coronary angiography were strikingly increased,the differences were statistically significant (P＜0.05).The results of multivariate logistic regression analysis showed that the independent correlative factors for ISR included hypertension (OR=1.12,95％CI:1.02-3.92;P=0.033),diabetes (OR=2.61,95％CI:1.93-4.26;P=0.016 0),Hcy (OR=2.45,95％CI:1.57-4.48;P=0.036),ox-LDL (OR=2.18,95％CI:1.45-4.96;P=0.006),taking statins (OR=0.50,95％CI:0.26-0.82;P=0.013),smoking (OR=5.62,95％CI:4.13-7.18;P=0.002),coronary artery disease (OR=3.32,95％CI:2.12-5.34;P=0.017),coronary bifurcation lesion (OR=3.51,95％CI:2.36-5.58;P=0.021),chronic total occlusion (OR=2.01,95％CI:1.22-4.84;P=0.014),reference vessel diameter (OR=0.25,95％CI:0.12-0.62;P=0.001),preoperative vascular stenosis degree (OR=2.06,95％ CI:1.21-4.32;P=0.024),stent diameter (OR=0.20,95％CI:0.10-0.53;P=0.001) and stent length (OR=2.60,95％CI:1.22-4.84;P=0.036).Conclusion Clinically,ISR is not an uncommon finding in patients who have received rapamycin-eluting coronary stent implantation.This study indicates that hypertension,diabetes,Hcy,ox-LDL,taking statins,smoking,coronary artery disease,coronary bifurcation lesion,chronic total occlusion,reference vessel diameter,preoperative vascular stenosis degree,stent diameter and stent length are the independent factors for ISR.Long-term use of statins can reduce the risk of ISR.