摘要
目的:通过对支架内血栓(stent thrombosis,ST)患者的长期随访,分析主要不良心血管事件(MACE)的发生率及其预测因素。方法:本研究连续入选2005-01-2012-09在我中心经冠状动脉造影明确诊断的ST患者。收集患者既往病史(2型糖尿病、高血压、陈旧性心肌梗死)、冠心病家族史、吸烟史、左室射血分数、血脂及肾功能水平、ST分型(早期、晚期和超晚期ST)、介入诊治经过(是否应用血栓抽吸、主动脉内球囊反搏、血小板Ⅱb/Ⅲa受体拮抗剂、再次植入支架、再次植入同一种类药物涂层支架以及术后TIMI血流等)、住院及随访期间的抗血小板、他汀类和血管转换酶抑制剂等药物治疗方案。记录患者住院及随访期间MACE(包括心源性死亡、再发明确的ST、非致死性心肌梗死以及靶血管重建等)。通过单因素分析及Cox回归分析确定MACE的预测因素。结果:54例ST患者入选,其中5例(9.3%)住院期间死亡,其余49例平均随访(48.1±25.1)个月,最短16个月,最长107个月。住院期间、1年、2年、3年、4年和5年的MACE发生率分别为14.8%、16.7%、20.7%、25.3%、29.3%和39.1%。Cox回归分析显示,具有冠心病家族史的ST患者MACE发生率增加3.36倍;双支血管ST的患者MACE发生率增加5.15倍。结论:经过长期随访发现,ST患者预后较差,MACE发生率逐年升高。冠心病家族史和双支血管ST是MACE的独立预测因素。
Objective：To evaluate the incidence and predictors of major adverse cardiac events （MACE） in pa- tients with angiographically confirmed stent thrombosis （ST）. Method：Consecutive patients with angiographically confirmed stent thrombosis in our center were enrolled from January 2005 to September 2012. Demographic data, medical history （diabetes mellitus, hypertension, myocardial infarction）, family history of coronary artery disease, smoking, left ventricular ejection factor, laboratory test results, the type of ST （early, late and very late）, treatments of intervention （aspiration thrombectomy, intra-aortic balloon pump, glycoprotein Ⅱb/Ⅲa inhibitor, additional stent implantation and TIMI flow grade） and medical therapy （antiplatelet agents, statins and angioten- sion converting enzyme inhibitor） administered to patients in hospital and during follow-up were collected. Death and MACE （including cardiac death, recurrent definite ST, non-fatal MI, and any ischemia-driven target-vessel revascularization） in hospital and during follow-up were recorded. Cox regression analysis was performed to assess the predictors for MACE. Result：Fifty four patients with angiographically confirmed stent thrombosis were repor- ted in our center. Among them, 5 patients died from cardiac-related causes in hospital. The average follow-up time for the remaining 49 patients was 48.14-25.1 months （16 to 107 months） until December 2013. The cumulative incidence of MACE in-hospital was 14.8%. And the incidences at 1, 2, 3, 4 and 5 years were 16.7%, 20.7%, 25.3 %, 29.3 % and 39.1%, respectively. On univariate analysis, family history of coronary artery disease, simultaneous two-vessel ST, HDL-C and multivessel disease were the potential predictors of MACE （all P〈0.10）.After using Cox regression analysis, family history of coronary artery disease （odds ratio： 3.36） and two-vessel ST （odds ratio： 5.15） were independent predictors of MACE in this cohort. Conclusion： Patients who suffered- from ST were considered to have a poor prognosis after long-term follow up. The cumulative incidence of MACE increased year by year. In addition, family history of coronary artery disease and simultaneous two-vessel ST were independent predictors of MACE.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2014年第7期607-612,共6页
Journal of Clinical Cardiology
关键词
支架
冠状动脉血栓
危险因素
冠心病家族史
stents
coronary thrombosis
risk factors
family history of coronary artery disease
