冠心病患者支架置入和经皮冠状动脉腔内成形术治疗后再狭窄的比较

A comparison of stent implantation with balloon angioplasty for restenosis in patients with coronary artery disease

目的 旨在分析冠心病患者冠状动脉 (冠脉 )支架置入和单纯球囊扩张 (PTCA)后晚期冠脉内径丢失及 6个月再狭窄发生率的差异 ,证实支架置入降低再狭窄作用并探讨可能机理。方法 冠心病介入治疗 35 2例中 ,选择连续 6 5例 (86个冠脉狭窄病变 )术后 6个月随访重复冠脉造影者 ,冠脉定量分析 (QCA)术前、术后和随访复查冠脉造影图象 ,并分析随访时内径丢失与支架置入和单纯球囊扩张的关系及术后 6个月再狭窄发生率。结果 冠脉内支架置入后随访期病变血管最小内径较大 ,而绝对内径丢失、相对内径丢失、绝对管腔面积丢失和内径丢失指数均低于单纯PTCA ,支架置入组再狭窄病变内径丢失百分比小于单纯PTCA组 ;再狭窄发生和支架置入呈负相关 (RR 0 86 ,95 %CI0 6 3～ 1 16 ,P <0 0 5 ) ;6个月 41例支架置入再狭窄 12例 (2 9 3% ) ,2 4例单纯PTCA再狭窄 12例(5 0 0 % ,P =0 0 6 9) ;5 3个支架置入病变再狭窄 14个 (2 6 4% ) ,33个单纯PTCA病变再狭窄 16个(48 5 % ,P =0 0 37)。

Objective To compare the restenosis rates between patients with coronary stent implantation and patients with coronary balloon angioplasty and confirm the reduction of restenosis with stenting Methods Quantitative coronary analysis was made in 65 patients (86 lesions) with the angiograms of pre intervention, post intervention and at follow up in all 352 patients with coronary angioplasty or coronary stenting The late loss and the rate of restenosis at 6 month follow up were compared between 41 patients with 53 stented lesions and 24 patients with 33 lesions treated with balloon angioplasty alone Results At follow up, larger minimum luminal diameter, smaller late loss, smaller luminal area, lower luminal index and lower luminal loss percentage were seen in the patients with stenting ( P <0 05) The restenosis was correlated significantly with stent implantation ( RR 0 86,95%CI 0 63～1 16, P <0 05) At 6 month, the patients with stenting had a lower rate of restenosis (29 3% vs 50 0% for patients, P =0 069;26 4% vs. 48 5% for lesions, P =0 037) than the patients with angioplasty alone Conclusion The reduction of restenosis with stenting was confirmed in Chinese patients with coronary artery disease