雷帕霉素洗脱支架在冠心病合并糖尿病患者中应用的远期临床疗效观察

Evaluation of long-term outcomes of rapamycin eluting stent in patients with coronary heart disease and diabetes.

目的 评价雷帕霉素洗脱支架在冠心病患者中应用1年后的疗效。方法 73例冠心病合并2型糖尿病患者置入雷帕霉素药物支架101枚，11枚（10.9％）为直接置入，其余90枚（89．1％）在置入前给予球囊预扩张。支架释放压力为8～16个大气压，其中39例（38．6％）进行了后扩张。所有患者术前、术后给予足量抗血小板药物。结果 手术成功率99．3％，73例患者均完成随访。平均随访时间为（15．4±3．5）个月。复发心绞痛6例（8．2％），急性心肌梗死1例（1，3％）。均接受了运动平板检查，其中阳性19例（26，0％），仅3例因为胸痛发作停止运动试验。19例（26．0％）运动平板结果阳性的患者在术后6～12个月内进行了冠状动脉造影复查。5例患者为药物支架内再狭窄，其中4例给予再次血管成形术。结论 雷帕霉素洗脱支架临床应用的远期效果良好，可减少再狭窄的发生。

Objective To evaluate the long term outcomes of rapamycin eluting stent in patients with coronary heart disease and diabetes one year later. Methods 73 CHD patients complicated with type 2 diabetes were treated with 101 rapamycin eluting stents. 11 （10.9% ） stents were implanted directly and the other 90 （ 89.1% ） was implanted with predilation. And postdilation was performed in 39 patients （ 38.6% ）. The stent was delivered within the pressure 8 to 16atm. All patients received aspirin and clopidogrel regularly before and after the procedure. Results Procedural success rate reached 99.3%, with completion of the follow-up in all the patients, averaging （ 15.4 ± 3.5 ） months. 6 patients suffered recurrent angina （ 8.2% ） and 1 had acute myocardial infarction （ 1. 3% ）. All patients received Hoher exercise showing that the result of 19 patients was positive （26.0% ） ,3 of who stopped exercise because of chest pain attack. The 19 cases received coronary artery angiography for reexamination within 6-12 months after operation. 5 patients had in-stent restenesis ,of who 4 received revaseularization. Conclusion Rapamycin eluting stent can be used safely and effectively, with better long-term results, which can reduce restenosis rate.