摘要
目的:探讨经皮冠状动脉(冠脉)介入治疗(PCI)后急性、亚急性支架内血栓形成(AST/SST)的危险因素及其冠脉造影特点,以早期识别高危患者并减少该并发症的发生。方法:回顾性分析2007-01至2011-01收治的冠心病行PCI术者5 129例的临床资料,其中冠脉造影证实AST/SST(AST/SST组)43例。按年龄、性别(3∶1)匹配原则抽取PCI术后未出现AST/SST者120例作为对照组。采用logistic回归模型分析AST/SST的独立危险因素。结果:AST/SST平均时间(4.1±5.7)d。院内死亡率13.95%(6/43)。AST/SST组糖尿病比例及血肌酐、空腹血糖高于对照组(P<0.05);AST/SST组支架置入前1周内心绞痛发作及1个月内急性心肌梗死史比例均高于对照组(P<0.05、<0.01),差异均有统计学意义。左心室射血分数、血压、血脂等各项指标差异均无统计学意义。冠脉造影AST/SST组出现B2/C病变比例、支架贴壁不良比例和支架数目均高于对照组,差异均有统计学意义(P<0.05~0.01)。应用条件lo-gistic回归分析确定PCI术后AST/SST的独立危险因素:糖尿病(比值比1.447,95%可信区间1.101~1.902,P=0.008)、急性心肌梗死(比值比7.177,95%可信区间1.956~26.328,P=0.003)、多支架置入(比值比2.186,95%可信区间1.326~3.604,P=0.002)、支架贴壁不良(比值比7.590,95%可信区间1.389~41.475,P=0.019)是AST/SST的独立危险因素,高左心室射血分数(比值比0.988,95%可信区间0.979~0.998,P=0.016)是PCI术后并发AST/SST的保护因素(P均<0.05)。结论:糖尿病、急性心肌梗死、多支架置入、支架贴壁不良是PCI术后并发AST/SST的独立危险因素。高左心室射血分数是PCI术后并发AST/SST的保护因素。
Objective:To analyze the risk factor of acute/sub-acute stentt thrombosis(AST/SST) in patients after percutaneous coronary intervention(PCI) in order to identify the high risk patients at early stage and to reduce such complication. Methods:We retrospectively reviewed 5129 coronary artery disease(CAD) patients undergoing PCI who admitted in our hos- pital from 2007 to 2011. Our work included 2 groups. AST/SST group,n=43 ,the patients with coronary angiography(CAG) con- firmed lesions, and Control group, n = 120, the patients with matched age and gender(3 : 1 ), and the patients had no AST/SST after PCL Logistic regression analysis was performed to identify the independent risk factors of AST/SST. Resuhs :AST/SST occurred at a median of(4. 1 ±5.7 )days after symptom onset, the in hospital mortality was 13.95% (6/ 43 ). Compared with Control group, AST/SST group had more diabetes mellitus, higher serum creatinine and fasting blood surger, all P〈0. 05. The occurrence of angina and AMI at 1 week and lmonth before stent implantation were higher in AST/SST group,P 〈0. 05 and P〈0. 01. Left ventricular ejection fraction (LVEF), blood pressure and blood lipids were similar in both groups, P〉0. 05. CAG presented that AST/SST group had more B2/C lesion, stent real-apposition and stent number,P〈0.05 -0.01. Logistic regression analysis indicated that the independent risk factors for AST/SST included diabetes mellitus (OR: 1. 447,95% CI: 1.101 - 1. 902, P = 0. 008 ), AMI ( OR : 7.177,95 % CI : 1. 956 - 26. 328, P = 0. 003 ), more stent number ( OR: 2. 186,95 % CI : 1. 326 -3. 604,P=0. 002) and stent mal-apposition( OR:7. 590,95% CI:1. 389 -al. 475 ,P=0. 019). High LVEF is a protec- tive factor for AST/SST(OR:0. 988,95% CI:0. 979 -0. 998,P=0. 016) occurrence after PCI. Conclusion: Diabetes mellitus, AMI, more stent number, stent mal-apposition are independent risk factors for AST/SST occurrence in CAD patients after PCI treatment. High LVEF is a protective factor for AST/SST complication.
出处
《中国循环杂志》
CSCD
北大核心
2013年第1期17-20,共4页
Chinese Circulation Journal