CAJ | 학술논문

目的观察药物洗脱支架(DES)置入后冠状动脉瘤(CAA)形成的危险因素和临床预后.方法 2004年1月至2009年5月,原位冠状动脉狭窄且置入DES的连续冠心病患者共4500例,入选其中有术后6～8个月和28～ 48个月冠状动脉造影随访资料的患者760例.CAA定义为冠状动脉局部管腔扩张,直径大于相邻正常血管的1.5倍.评估CAA形成的独立危险因素,随访主要不良心脏事件(心脏性死亡、心肌梗死、靶血管血运重建和支架内血栓形成)的发生率.结果随访发现70例患者的70处(9.2％,70/760)病变形成CAA.logistic回归分析显示,梗死相关动脉病变(OR:5.9,P＜0.01)、靶血管为左前降支(OR:4.5,P＜0.01)、慢性完全闭塞病变(OR:3.4,P＜0.05)、病变长度＞33 mm(OR:2.9,P＜0.05)为DES置入后CAA形成的独立危险因素.随访(1131 ±478)d,19例患者发生主要不良心脏事件,8例患者发生支架内血栓形成导致的急性心肌梗死,无患者死亡.结论梗死相关动脉病变、靶血管为左前降支、慢性完全闭塞病变、病变长度＞ 33 mm为DES置入后CAA形成的独立危险因子；CAA患者有可能发生主要不良心脏事件,需要长期临床随访观察其预后.
목적 관찰약물세탈지가(DES)치입후관상동맥류(CAA)형성적위험인소화림상예후.방법 2004년1월지2009년5월,원위관상동맥협착차치입DES적련속관심병환자공4500례,입선기중유술후6～8개월화28～ 48개월관상동맥조영수방자료적환자760례.CAA정의위관상동맥국부관강확장,직경대우상린정상혈관적1.5배.평고CAA형성적독립위험인소,수방주요불양심장사건(심장성사망、심기경사、파혈관혈운중건화지가내혈전형성)적발생솔.결과 수방발현70례환자적70처(9.2％,70/760)병변형성CAA.logistic회귀분석현시,경사상관동맥병변(OR:5.9,P＜0.01)、파혈관위좌전강지(OR:4.5,P＜0.01)、만성완전폐새병변(OR:3.4,P＜0.05)、병변장도＞33 mm(OR:2.9,P＜0.05)위DES치입후CAA형성적독립위험인소.수방(1131 ±478)d,19례환자발생주요불양심장사건,8례환자발생지가내혈전형성도치적급성심기경사,무환자사망.결론 경사상관동맥병변、파혈관위좌전강지、만성완전폐새병변、병변장도＞ 33 mm위DES치입후CAA형성적독립위험인자；CAA환자유가능발생주요불양심장사건,수요장기림상수방관찰기예후.
Objective To evaluate risk factors and clinical outcome of coronary artery aneurysms (CAA) developed after drug-eluting stent implantation evidenced by coronary angiographic followup.Methods This study analyzed 4500 consecutive patient with de novo coronary artery stenosis receiving drug-eluting stent (DES) implantation from January 2004 to May 2009.Seven hundred and sixty patients with angiographic follow-ups at 6-8 months and 28-48 months after the index procedure were enrolled.CAA was defined as a localized dilatation exceeding 1.5 times the diameter of the adjacent artery.The independent risk factors and major adverse cardiac events (MACE) including cardiac death,myocardial infarction,target-vessel revascularization (TVR) and in-stent thrombosis were analyzed.Results CAA was detected in 70 patients with 70 lesions (9.2％,70/760).Logistic analysis showed that lesion in an infarctrelated artery (OR: 5.9,P ＜ 0.01),lesion in the left anterior descending artery (OR: 4.5,P ＜ 0.01),lesion with chronic total occlusion (OR: 3.4,P ＜ 0.05),and lesion length ＞ 33 mm (OR: 2.9,P ＜ 0.05)were independent risk factors for CAA.Follow-up duration was (1131 ±478) days.MACE was found in 19 patients and all received TVR.There were 11 patients with myocardial infarction and 8 patients with evidence of in-stent thrombosis.Mortality was zero during follow-up.Conclusions The risk factors for the development of CAA after DES are lesions in an infarct-related artery,in the left anterior descending artery,with chronic total occlusion,and with lesion length ＞ 33 mm.MACE is not uncommon in patients with CAA and long-ferm clinical follow-up is warranted for patients with CAA.