中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
13期
12-15
,共4页
周昆林%施鸿毓%陈晖%仇兴标%曲新凯%方唯一
週昆林%施鴻毓%陳暉%仇興標%麯新凱%方唯一
주곤림%시홍육%진휘%구흥표%곡신개%방유일
药物洗脱支架%支架内再狭窄%经皮介入治疗
藥物洗脫支架%支架內再狹窄%經皮介入治療
약물세탈지가%지가내재협착%경피개입치료
Drug eluting stent%In-stent restenosis%Percutaneous coronary intervention
目的 评价药物洗脱支架内再狭窄患者不同再狭窄类型的临床特点及其与远期预后的关系.方法 入选2006年9月至2009年12月因支架内再狭窄行介入治疗的冠心病患者,根据其再狭窄特点分为局灶型及非局灶型.所有患者均进行前瞻性随访主要心血管不良事件(MACE),包括死亡、再次介入治疗和心肌梗死.结果 研究共入选88例患者,其中局灶型患者40例,非局灶型患者48例.局灶型与非局灶型患者年龄、性别构成、危险因素、临床表现及用药情况等比较差异无统计学意义(P＞0.05).与局灶型相比,非局灶型节段内再狭窄比例较高[58.3％(28/48)比12.5％(5/40),P＜0.0l],狭窄程度较重[(78.1±10.0)％比(70.0±9.7)％,P＜0.01],需要再次植入药物洗脱支架的比例较高[81.2％(39/48)比17.5％(7/40),P＜0.01],再次植入支架长度更长[(25.0±7.0) mm比(17.4±3.4) mm,P＜0.01].随访时间(2.2±1.0)年.虽然局灶型与非局灶型患者在MACE、死亡、再次介入治疗及心肌梗死方面比较差异无统计学意义(P＞0.05),但非局灶型患者MACE发生率较局灶型有升高趋势[22.9％ (11/48)比10.0％(4/40),P=0.092].结论 非局灶型药物支架内再狭窄病变影像学特点较局灶型严重,大都需要再次植入药物洗脱支架,其远期预后较局灶型病变差.
目的 評價藥物洗脫支架內再狹窄患者不同再狹窄類型的臨床特點及其與遠期預後的關繫.方法 入選2006年9月至2009年12月因支架內再狹窄行介入治療的冠心病患者,根據其再狹窄特點分為跼竈型及非跼竈型.所有患者均進行前瞻性隨訪主要心血管不良事件(MACE),包括死亡、再次介入治療和心肌梗死.結果 研究共入選88例患者,其中跼竈型患者40例,非跼竈型患者48例.跼竈型與非跼竈型患者年齡、性彆構成、危險因素、臨床錶現及用藥情況等比較差異無統計學意義(P＞0.05).與跼竈型相比,非跼竈型節段內再狹窄比例較高[58.3％(28/48)比12.5％(5/40),P＜0.0l],狹窄程度較重[(78.1±10.0)％比(70.0±9.7)％,P＜0.01],需要再次植入藥物洗脫支架的比例較高[81.2％(39/48)比17.5％(7/40),P＜0.01],再次植入支架長度更長[(25.0±7.0) mm比(17.4±3.4) mm,P＜0.01].隨訪時間(2.2±1.0)年.雖然跼竈型與非跼竈型患者在MACE、死亡、再次介入治療及心肌梗死方麵比較差異無統計學意義(P＞0.05),但非跼竈型患者MACE髮生率較跼竈型有升高趨勢[22.9％ (11/48)比10.0％(4/40),P=0.092].結論 非跼竈型藥物支架內再狹窄病變影像學特點較跼竈型嚴重,大都需要再次植入藥物洗脫支架,其遠期預後較跼竈型病變差.
목적 평개약물세탈지가내재협착환자불동재협착류형적림상특점급기여원기예후적관계.방법 입선2006년9월지2009년12월인지가내재협착행개입치료적관심병환자,근거기재협착특점분위국조형급비국조형.소유환자균진행전첨성수방주요심혈관불량사건(MACE),포괄사망、재차개입치료화심기경사.결과 연구공입선88례환자,기중국조형환자40례,비국조형환자48례.국조형여비국조형환자년령、성별구성、위험인소、림상표현급용약정황등비교차이무통계학의의(P＞0.05).여국조형상비,비국조형절단내재협착비례교고[58.3％(28/48)비12.5％(5/40),P＜0.0l],협착정도교중[(78.1±10.0)％비(70.0±9.7)％,P＜0.01],수요재차식입약물세탈지가적비례교고[81.2％(39/48)비17.5％(7/40),P＜0.01],재차식입지가장도경장[(25.0±7.0) mm비(17.4±3.4) mm,P＜0.01].수방시간(2.2±1.0)년.수연국조형여비국조형환자재MACE、사망、재차개입치료급심기경사방면비교차이무통계학의의(P＞0.05),단비국조형환자MACE발생솔교국조형유승고추세[22.9％ (11/48)비10.0％(4/40),P=0.092].결론 비국조형약물지가내재협착병변영상학특점교국조형엄중,대도수요재차식입약물세탈지가,기원기예후교국조형병변차.
Objective To evaluate the clinical features of in-stent restenosis after drug eluting stent (DES) implantation and investigate the relationship between different patterns of DES restenostic lesions and long-term prognosis.Methods All scoronary heart disease patients who underwent repeated pereutaneous coronary intervention (PCI) for DES in-stent restenosis from September 2006 to December 2009 were enrolled.All patients were divided into focal group and non-focal group according to the pattern of restenosis.All patients were prospectively followed up for major adverse cardiovascular event (MACE) including death,repeat PCI and myocardial infarction.Results Totally 88 patients (40 with focal restenosis,48 with non-focal restenosis) were enrolled.There were no significant differences between two groups in age,gender,risk factors,clinical presentation and medical therapy (P ＞ 0.05).Compared with that in focal group,the patients in non-focal group had a higher portion of in-segment restenosis [58.3％ (28/48) vs.12.5％(5/40),P＜ 0.01],higher stenosis rate [(78.1 ± 10.0)％ vs.(70.0 ± 9.7)％,P ＜ 0.01],more need for another DES[81.2％(39/48) vs.17.5％(7/40),P＜ 0.01],and longer stent implanted [(25.0 ± 7.0) mm vs.(17.4 ±3.4) mm,P ＜0.01].After following up for (2.2 ± 1.0) years,there were no significant differences between two groups in MACE and each component (P ＞ 0.05),however,compared with that in focal group,there was a trend of increase in MACE in non-focal group[22.9％(11/48) vs.10.0％(4/40),P=0.092].Conclusion It suggests that patients with non-focal restenosis have a more severe lesion angiographically,which usually results in another DES implanted,and has a worse long-term prognosis.
