经皮冠状动脉介入治疗术后急性、亚急性支架内血栓形成的危险因素分析

Risk Factor Analysis of Acute and Sub-Acute In-Stent Thrombosis in Patients AfterPercutaneous Coronary Intervention Treatment

目的:探讨经皮冠状动脉(冠脉)介入治疗(PCI)后急性、亚急性支架内血栓形成(AST/SST)的危险因素及其冠脉造影特点,以早期识别高危患者并减少该并发症的发生。方法:回顾性分析2007-01至2011-01收治的冠心病行PCI术者5 129例的临床资料,其中冠脉造影证实AST/SST(AST/SST组)43例。按年龄、性别(3∶1)匹配原则抽取PCI术后未出现AST/SST者120例作为对照组。采用logistic回归模型分析AST/SST的独立危险因素。结果:AST/SST平均时间(4.1±5.7)d。院内死亡率13.95%(6/43)。AST/SST组糖尿病比例及血肌酐、空腹血糖高于对照组(P<0.05);AST/SST组支架置入前1周内心绞痛发作及1个月内急性心肌梗死史比例均高于对照组(P<0.05、<0.01),差异均有统计学意义。左心室射血分数、血压、血脂等各项指标差异均无统计学意义。冠脉造影AST/SST组出现B2/C病变比例、支架贴壁不良比例和支架数目均高于对照组,差异均有统计学意义(P<0.05～0.01)。应用条件lo-gistic回归分析确定PCI术后AST/SST的独立危险因素:糖尿病(比值比1.447,95%可信区间1.101～1.902,P=0.008)、急性心肌梗死(比值比7.177,95%可信区间1.956～26.328,P=0.003)、多支架置入(比值比2.186,95%可信区间1.326～3.604,P=0.002)、支架贴壁不良(比值比7.590,95%可信区间1.389～41.475,P=0.019)是AST/SST的独立危险因素,高左心室射血分数(比值比0.988,95%可信区间0.979～0.998,P=0.016)是PCI术后并发AST/SST的保护因素(P均<0.05)。结论:糖尿病、急性心肌梗死、多支架置入、支架贴壁不良是PCI术后并发AST/SST的独立危险因素。高左心室射血分数是PCI术后并发AST/SST的保护因素。

Objective：To analyze the risk factor of acute/sub-acute stentt thrombosis（AST/SST） in patients after percutaneous coronary intervention（PCI） in order to identify the high risk patients at early stage and to reduce such complication. Methods：We retrospectively reviewed 5129 coronary artery disease（CAD） patients undergoing PCI who admitted in our hos- pital from 2007 to 2011. Our work included 2 groups. AST/SST group,n=43 ,the patients with coronary angiography（CAG） con- firmed lesions, and Control group, n = 120, the patients with matched age and gender（3 ： 1 ）, and the patients had no AST/SST after PCL Logistic regression analysis was performed to identify the independent risk factors of AST/SST. Resuhs ：AST/SST occurred at a median of（4. 1 ±5.7 ）days after symptom onset, the in hospital mortality was 13.95% （6/ 43 ）. Compared with Control group, AST/SST group had more diabetes mellitus, higher serum creatinine and fasting blood surger, all P〈0. 05. The occurrence of angina and AMI at 1 week and lmonth before stent implantation were higher in AST/SST group,P 〈0. 05 and P〈0. 01. Left ventricular ejection fraction （LVEF）, blood pressure and blood lipids were similar in both groups, P〉0. 05. CAG presented that AST/SST group had more B2/C lesion, stent real-apposition and stent number,P〈0.05 -0.01. Logistic regression analysis indicated that the independent risk factors for AST/SST included diabetes mellitus （OR： 1. 447,95% CI： 1.101 - 1. 902, P = 0. 008 ）, AMI （ OR ： 7.177,95 % CI ： 1. 956 - 26. 328, P = 0. 003 ）, more stent number （ OR： 2. 186,95 % CI ： 1. 326 -3. 604,P=0. 002） and stent mal-apposition（ OR：7. 590,95% CI：1. 389 -al. 475 ,P=0. 019）. High LVEF is a protec- tive factor for AST/SST（OR：0. 988,95% CI：0. 979 -0. 998,P=0. 016） occurrence after PCI. Conclusion： Diabetes mellitus, AMI, more stent number, stent mal-apposition are independent risk factors for AST/SST occurrence in CAD patients after PCI treatment. High LVEF is a protective factor for AST/SST complication.