CAJ | 학술논문

目的：比较局部和全程支架植入术对冠状动脉弥漫性病变的临床疗效。方法回顾性分析2008年1月至2012年3月接受冠状动脉内支架植入术治疗的弥漫性病变患者106例，其中63例接受全程支架植入治疗（支架覆盖全程病变，全程支架组）。另43例接受局部支架植入治疗（支架只覆盖弥漫性病变中狭窄≥70%管腔，局部支架组）；根据靶血管的血管直径分为弥漫性小血管病变（血管直径2.5～3.0 mm）、弥漫性大血管病变（血管直径≥3.0 mm）。随访1年，比较两组主要不良心血管事件（术后心绞痛、心源性死亡、非致死性心肌梗死、靶血管再次血运重建）以及支架再狭窄的发生率。结果对于弥漫性小血管病变，与局部支架组比较，全程支架组的术后心绞痛、心源性死亡、非致死性心肌梗死、靶血管再次血运重建和支架再狭窄的发生率较高（21.1%vs.15.8%，5.3%vs.0.0%，21.1%vs.10.5%，21.1%vs.10.5%，31.6%vs.21.5%，P均＜0.05）；对于弥漫性大血管病变，与局部支架组比较，全程支架组的术后心绞痛、心源性死亡、非致死性心肌梗死、靶血管再次血运重建的发生率较低（8.8%vs.16.7%，2.9%vs.4.2%，5.9%vs.12.5%，5.9%vs.12.5%，P均＜0.05），支架再狭窄的发生率没有明显差异（20.5%vs.20.8%，P＞0.05）。结论全程支架植入治疗能降低冠状动脉弥漫性大血管病变远期主要不良心血管事件，而局部支架能更好降低弥漫性小血管病变远期主要不良心血管事件。
목적：비교국부화전정지가식입술대관상동맥미만성병변적림상료효。방법회고성분석2008년1월지2012년3월접수관상동맥내지가식입술치료적미만성병변환자106례，기중63례접수전정지가식입치료（지가복개전정병변，전정지가조）。령43례접수국부지가식입치료（지가지복개미만성병변중협착≥70%관강，국부지가조）；근거파혈관적혈관직경분위미만성소혈관병변（혈관직경2.5～3.0 mm）、미만성대혈관병변（혈관직경≥3.0 mm）。수방1년，비교량조주요불양심혈관사건（술후심교통、심원성사망、비치사성심기경사、파혈관재차혈운중건）이급지가재협착적발생솔。결과대우미만성소혈관병변，여국부지가조비교，전정지가조적술후심교통、심원성사망、비치사성심기경사、파혈관재차혈운중건화지가재협착적발생솔교고（21.1%vs.15.8%，5.3%vs.0.0%，21.1%vs.10.5%，21.1%vs.10.5%，31.6%vs.21.5%，P균＜0.05）；대우미만성대혈관병변，여국부지가조비교，전정지가조적술후심교통、심원성사망、비치사성심기경사、파혈관재차혈운중건적발생솔교저（8.8%vs.16.7%，2.9%vs.4.2%，5.9%vs.12.5%，5.9%vs.12.5%，P균＜0.05），지가재협착적발생솔몰유명현차이（20.5%vs.20.8%，P＞0.05）。결론전정지가식입치료능강저관상동맥미만성대혈관병변원기주요불양심혈관사건，이국부지가능경호강저미만성소혈관병변원기주요불양심혈관사건。
Objective To compare the clinical efficacy of Partial and full stent implantation for diffuse coronary artery disease. Methods One hundred and six diffuse coronary artery patients who had went through coronary artery stent implantation during 2008.1 to 2012.3 were analyzed and divided into two groups, Of which 63 patients underwent full stent implantation were for the full stent group(stent cover the entire lesion)and 43 patients underwent partial stent implantation were for the partial stent group(Stent covered only diffuse lesions≥70%stenosis lumen). These 106 cases were divided into diffuse small vascular disease(vessel diameter 2.5-3.0 mm) and diffuse macrovascular disease(vessel diameter≥3.0 mm according to the target vessel vessel diameter.After one year's following up, major cardiovascular events(postoperative angina, cardiac death, nonfatal myocardial infarction, target vessel revascularization) and the incidence of stent restenosis were compared . Results For diffuse small vascular disease, the incidence of adverse cardiovascular events and stent restenosis in full stent group were higher than in the partial stent group(incidence of angina, cardiac death, nonfatal myocardial infarction, target vessel revascularization compared were respectively 21.1% vs. 15.8%, 5.3% vs. 0.0%, 21.1% vs. 10.5%, 21.1% vs. 10.5%, 31.6% vs. 21.5%, P<0.05). For diffuse macrovascular disease, the incidence of adverse cardiovascular events in the full stent group were lower than in the partial stent group(incidence of angina, cardiac death, nonfatal myocardial infarction, target vessel revascularization compared were respectively 8.8%vs. 16.7%, 2.9%vs. 4.2%, 5.9%vs. 12.5%, 5.9%vs. 12.5%, P<0.05), but stent restenosis rates were similar (20.5%vs. 20.8%, P>0.05). Conclusion Partial stent implantation can reduce long-term major cardiovascular events of diffuse coronary artery macrovascular disease, while partial stent can reduce long-term major cardiovascular events of diffuse small vascular disease better.