药物洗脱支架置入后冠状动脉瘤形成的危险因素和预后

Risk factors and clinical outcome of coronary artery aneurysms developed after drug-eluting stent implantation

目的观察药物洗脱支架（DES）置入后冠状动脉瘤（CAA）形成的危险因素和临床预后。方法2004年1月至2009年5月，原位冠状动脉狭窄且置入DES的连续冠心病患者共4500例，入选其中有术后6～8个月和28～48个月冠状动脉造影随访资料的患者760例。CAA定义为冠状动脉局部管腔扩张，直径大于相邻正常血管的1．5倍。评估CAA形成的独立危险因素，随访主要不良心脏事件（心脏性死亡、心肌梗死、靶血管血运重建和支架内血栓形成）的发生率。结果随访发现70例患者的70处（9．2％，70／760）病变形成CAA。logistic回归分析显示，梗死相关动脉病变（OR：5．9，P〈0．01）、靶血管为左前降支（OR：4．5，P〈0．01）、慢性完全闭塞病变（OR：3．4，P〈0．05）、病变长度〉33mm（OR：2．9，P〈0．05）为DES置入后CAA形成的独立危险因素。随访（1131±478）d，19例患者发生主要不良心脏事件，8例患者发生支架内血栓形成导致的急性心肌梗死，无患者死亡。结论梗死相关动脉病变、靶血管为左前降支、慢性完全闭塞病变、病变长度〉33mm为DES置人后CAA形成的独立危险因子；CAA患者有可能发生主要不良心脏事件，需要长期临床随访观察其预后。

Objective To evaluate risk factors and clinical outcome of coronary artery aneurysms （CAA） developed after drug-eluting stent implantation evidenced by coronary angiographic follow- up. Methods This study analyzed 4500 consecutive patient with de novo coronary artery stenosis receiving drug-eluting stent （DES） implantation from January 2004 to May 2009. Seven hundred and sixty patients with angiographic follow-ups at 6 - 8 months and 28 - 48 months after the index procedure were enrolled. CAA was defined as a localized dilatation exceeding 1.5 times the diameter of the adjacent artery. The independent risk factors and major adverse cardiac events （MACE） including cardiac death, myocardial infarction, target-vessel revascularization （TVR） and in-stent thrombosis were analyzed. Results CAA was detected in 70 patients with 70 lesions （9. 2% ,70/760）. Logistic analysis showed that lesion in an infarct- related artery （ OR ： 5.9, P 〈 0. 01 ）, lesion in the left anterior descending artery （ OR ： 4. 5, P 〈 0. 01 ）, lesion with chronic total occlusion （ OR： 3.4, P 〈 0. 05 ）, and lesion length 〉 33 mm （ OR ： 2. 9,P 〈 O. 05 ） were independent risk factors for CAA. Follow-up duration was （1131 _＋ 478） days. MACE was found in 19 patients and all received TVR. There were 11 patients with myocardial infarction and 8 patients with evidence of in-stent thrombosis. Mortality was zero during follow-up. Conclusions The risk factors for the development of CAA after DES are lesions in an infarct-related artery, in the left anterior descending artery, with chronic total occlusion, and with lesion length 〉 33 mm. MACE is not uncommon in patients with CAA and long-ferm clinical follow-up is warranted for patients with CAA.