直接冠状动脉介入治疗支架内血栓形成的发生率、危险因素及预后

Frequency, risk factors and prognosis of stent thrombosis after primary percutaneous coronary intervention

目的 分析过去 5年期间常规开展ST段抬高性心肌梗死 (STEMI)直接经皮冠状动脉介入治疗 (PCI)支架内血栓形成的发生率、危险因素以及对预后的影响。方法 1999年 3月至 2 0 0 4年 2月 5年期间常规对 311例STEMI患者经股动脉或桡动脉施行直接PCI。男 2 5 0例 ,女 6 1例 ,平均年龄6 0 4岁 (2 6～ 85岁 )。围手术期采用阿司匹林、氯吡格雷或噻氯匹定、肝素进行标准的三联抗血小板 抗凝治疗。对全部患者随访两个月以上。结果 直接PCI手术操作成功率 99% (30 8 311)。 8例发生9例次支架内急性 亚急性或后期血栓形成 ,发生率为 2 6 % (8 30 8)。其中急性血栓形成 5例 ,亚急性或后期血栓形成 3例。这 8例患者均有血栓形成的多个高危因素。 8例中住院死亡 3例 ,其余 5例有明显的左心室收缩功能障碍。结论 STEMI直接PCI后的血栓形成发生率较高 ,小直径的长支架和缺乏有效的抗血小板治疗可能是血栓形成的主要危险因素 ,血栓形成患者的死亡率高 ,临床长期预后差。

Objective To analyse frequency, risk factors and prognosis of stent thrombosis after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) during the last five-year period. Methods Primary PCI was performed in 311 patients with STEMI including 250 males and 61 females with an average age of 60.4 years (26～85 years). The standard triple antiplatelet/anticoagulation therapy with aspirin and clopidogreal plus heparin was used pre- and post-interventional procedure. All patients underwent more than two months follow-up investigation. Results A successful primary PCI procedure was achieved in 99% (308/311) STEMI patients with incidence of total stent thrombosis in 2.6% (8/308), including acute stent thrombosis in five patients and subacute or late thrombosis in three patients. Multiple risk factors could be identified in all the eight patients, of whom, three died of acute closure events and the follow-up study in the other five showed severe systolic dysfunction of left ventricle. Conclusion High incidence of stent thrombosis occurred after primary PCI for STEMI with high mortality and poor clinical prognosis. Application of small diameter and/or long stents and discontinuation of clopidogreal seem to be major risk factors.