急性冠脉综合征患者药物洗脱支架雷帕霉素Cypher^(TM)植入后的不良反应分析

Analysis of Adverse Reactions of Cypher Drug Eluting Stent Implantation in Treatment of Acute Coronary Syndrome

目的:分析雷帕霉素药物洗脱支架CypherTM植入后对急性冠脉综合征患者近、远期的不良反应。方法:选择接受CypherTM治疗的冠心病患者83例,在支架植入术后9个月内全部接受门诊随访及冠脉造影,了解支架内急性和亚急性血栓、边缘效应、贴壁不良现象、支架处动脉瘤发生率及相应的不良心脏事件(MACE)发生情况。结果:83例患者共植入支架112个,植入成功率为98.8%(82/83)。29例(34.9%)接受冠脉造影,MACE9例,发生率10.8%(9/83),其中,1例术中发生猝死,1例术后3d因亚急性血栓造成再发心肌梗死,其余7例在出院后1～3月内发生心绞痛,皆经造影证实为血栓形成,再次成功靶血管血运重建8例;其余20例无症状患者造影发现支架边缘狭窄(无血栓)2例,总再狭窄为13.3%(11/83);无动脉瘤发生。9例MACE中,有弥漫病变5例,其中4例植入长支架,1例植入重叠支架,其余为简单病变;29例患者共发现贴壁不良现象5例,皆发生MACE,其中4例为弥漫病变植入长支架,1例为简单病变。结论:急性或亚急性血栓形成是药物支架CypherTM植入后出现的主要不良反应,可能与弥漫病变植入长、重叠支架引起贴壁不良有关。

Objective：To analyse the adverse reactions of Cypher drug eluting stent implantation in treatment of patients with coronary heart diseases （CHD）. Methods： Eighty-three patients with CHD underwent coronary artery Cypher drug eluting stent（DES） implantation were followed-up by outpatient visiting and angiography to analyse the rate of the acute and subacute stent thrombosis, edge effect, malapposition, aneurysm formation and major adverse cardiac event （MACE） for 9 months after implantation. Results： One hundred twelve DES were implanted for coronary artery lesions in 83 patients, the success rate of stent implantation was 98.8% （82/83）. Twenty-nine patients （34. 9%） received angiography checking, the rate of MACE were 10. 8% （9/83）, including 1 case with sudden death, 1 case with acute myocardial infarction （AMI） from subacute thrombosis 3 days after operation, 7 patients with unstable angina pectoris due to thrombus during 1 to 3 months after discharge,8 cases achieved success revascularization. Two patients with stent edge effect were detected by angiography in 20 symptom free patients, the total rate of restenosis was 13. 3%（11/83）. No aneurysm occured. In the 9 MACE patients,5 patients with diffuse lesion received 4 long, 1 overlapping stents implantation, in 29 patients 5 with malapposition,4 of them had diffuse lesions and received 4 long stents implantation, all 5 patients developed MACE. Conclusion.- Acute or subacute stent thrombosis was the major adverse reactions in Cypher drug eluting stent implantation which was related to malapposition induced by long stents or overlapping stenting implantation in diffuse lesion.