药物洗脱支架在急性ST段抬高型心肌梗死患者介入术后血栓形成的相关因素分析

Analysis of the related factors of drug-eluting stent thrombosis after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

目的:探讨ST段抬高性心肌梗死患者经皮冠状动脉介入置入雷帕霉素药物洗脱支架内血栓形成的相关因素及预后。方法:845例ST段抬高型心肌梗死患者行直接经皮冠状动脉介入置入雷帕霉素药物洗脱支架,随访6个月,分析21例发生血栓形成的相关因素及预后。结果:血栓形成发生率2.49%,血栓形成组与无血栓形成组在年龄、糖尿病、左室射血分数、停用氯吡格雷、6个月病死率、再次靶血管重建率及再次靶病变重建率等方面差异有统计学意义(P<0.05)。多因素分析显示糖尿病史、左室射血分数、停用抗血小板药物、前降支病变、支架直径、数量及长度是血栓形成的独立影响因素。结论:雷帕霉素药物洗脱支架血栓形成是多因素相关的临床事件,患者病死率高,预后差,应引起高度重视。

Objective To study the related factors and prognosis of rapamycin drug-eluting stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Methods Percutaneous coronary intervention was performed in 845 patients with ST- segment elevation myocardial infarction which were implanted rapamycin drug-eluting stent. All the patient were followed up for 6 months. Stent thrombosis occurred in 21 patients and the related factors and prognosis were analyzed. Results The incidence of stent thrombosis was 2. 49%. Stent thrombosis was associated with an increased risk of stent thrombosis, including age, diabetes, left ventricular eject fraction, premature cessation of clopidogrel, the mortality, re-TVR and re-TLR at 6 months（P〈0. 05）. Multivariate analysis showed that the age, diabetes, left ventricular eject fraction, cessation of clopidogrel, diameter, number and length of stent were independent risk factors of stent thrombosis. Conclusion Rapamycin drug-eluting stent thrombosis is a clinical event of multiple factor with high fatality and poor clinical prognosis, and should be paid much attention.