国产药物洗脱支架在急诊冠脉介入治疗中导致急性支架内血栓形成的临床分析

Clinical features of acute stent thrombosis after successful primary percutaneous coronary intervention with domestic drug-eluting stents in patients with acute ST elevation myocardial infarction

目的分析急性ST段抬高型心肌梗死急诊介入治疗应用国产雷帕霉素药物洗脱支架(DES)导致急性支架内血栓形成的临床相关因素。方法回顾性分析我院心内科2005年11月至2007年12月因急性心肌梗死行急诊冠状动脉介入治疗并且置入国产DES支架的429例患者中发生急性支架内血栓形成的7例患者的临床资料、支架释放情况以及术前抗血小板治疗等相关因素。结果7例患者均具有多项心血管危险因素,其梗死相关血管1例为左前降支,6例为右冠状动脉而且均为弥漫长病变、术前服用双重抗血小板药物到支架置入时间为(124.2±3.7)min、支架释放压力为(1261.39±213.78)kpa,有5例患者行高压球囊支架内后扩张,平均扩张压力为(1491.39±169.20)kPa,平均次数为(2.8±1.5)次;血栓发生后有3例患者经重复球囊扩张,1例经再次置入支架,3例静脉滴注替罗非班等治疗好转,无1例死亡。结论国产DES治疗急性ST段抬高型心肌梗死而导致急性支架内血栓形成的患者多具有多重心血管危险因素。其支架内急性血栓形成的原因,可能与梗死相关血管为弥漫长病变,且多为右冠状动脉、术前服用抗血小板治疗不充分、支架释放后多次高压后扩张等因素有关。经再次冠状动脉内介入治疗和使用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂治疗是安全、有效的。

Objective To analyze the potential risk factors for patients with acute ST elevation myocardial infarction developing acute stent thrombosis （AST） after successful primary percutaneous coronary intervention with domestic drug-eluting stents. Methods The clinical, procedural as well as anti-platelet therapy data were retrospectively analyzed in 7 patients with AST after successful primary percutaneous coronary intervention with domestic drug-eluting stents implantation. Results Of all patients had diffuse and long lesions of target vessels, which 1 in left anterior descending and 6 in right coronary artery, as well as with multiple risk factors of cardiovascular disease. The mean intervals of dual anti-platelet therapy to stents deployment was （124.2±3.7）min. The mean release pressure of stents was （1261.39±213.78）kPa. 5 patients undergone high-pressure dilation after the procedure, with which mean pressure（ 1491.39±169.2）kpa and （2.8±1.5） dilation times.After developing AST,3 cases treated with repeat balloon dilation, 1 with repeat stent implanted and 3 with intravenous tirofiban and no patients were died. Conclusion AST could be safe and effective treated with repeat percutaneous coronary intervention and intravenous tirofiban. The development of AST after successful primary percutaneous coronary intervention with domestic drugeluting stents were probably associated with the following factors：patients with multiple risk factors of cardiovascular diseases, infarction related artery was mostly located in right coronary artery and with diffuse and long lesions, short intervals of dual anti-platelet therapy before procedure,implanted stents with many times of high-pressure dilation after the procedure.