药物洗脱支架内再狭窄的临床特点及预后分析

Clinical features and prognosis of in-stent restenosis after drug eluting stent implantation

目的评价药物洗脱支架内再狭窄患者不同再狭窄类型的临床特点及其与远期预后的关系。方法人选2006年9月至2009年12月因支架内再狭窄行介入治疗的冠心病患者，根据其再狭窄特点分为局灶型及非局灶型。所有患者均进行前瞻『生随访主要心血管不良事件（MACE），包括死亡、再次介入治疗和心肌梗死。结果研究共入选88例患者，其中局灶型患者40例，非局灶型患者48例。局灶型与非局灶型患者年龄、性别构成、危险因素、临床表现及用药情况等比较差异无统计学意义（P〉0．05）。与局灶型相比，非局灶型节段内再狭窄比例较高[58．3％（28，48）比12．5％（5／40），P〈0．01]，狭窄程度较重[（78．1±10．0）％比（70．0±9．7）％，P〈O．01]，需要再次植入药物洗脱支架的比例较高[81．2％（39／48）比17．5％（7／40），P〈0．01]，再次植入支架长度更长[（25．0±7．0）mm比（17．4±3．4）mm，P〈O．01]。随访时间（2．2±1．0）年。虽然局灶型与非局灶型患者在MACE、死亡、再次介入治疗及心肌梗死方面比较差异无统计学意义（P〉0．05），但非局灶型患者MACE发生率较局灶型有升高趋势[22．9％（11／48）比10．0％（4／40），P=0．092]。结论非局灶型药物支架内再狭窄病变影像学特点较局灶型严重，大都需要再次植入药物洗脱支架，其远期预后较局灶型病变差。

Objective To evaluate the clinical features of in-stent restenosis after drug eluting stent （DES） implantation and investigate the relationship between different patterns of DES restenostic lesions and long-term prognosis. Methods All scoronary heart disease patients who underwent repeated pereutaneous coronary intervention （PCI） for DES in-stent restenosis from September 2006 to December 2009 were enrolled. All patients were divided into focal group and non-focal group according to the pattern of restenosis. All patients were prospectively followed up for major adverse cardiovascular event （MACE） including death, repeat PCI and myocardial infarction. Results Totally 88 patients （40 with focal restenosis, 48 with non-focal restenosis） were enrolled. There were no significant differences between two groups in age, gender,risk factors, clinical presentation and medical therapy （P 〉0.05）. Compared with that in focal group, the patients in non-focal group had a higher portion of in-segment restenosis [58.3% （28/48） vs. 12.5%（5/40）,P〈 0.01 ], higher stenosis rate [（78.1 ± 10.0）% vs. （70.0 ± 9.7）%,P〈 0.01 ], more need for another DES[ 81.2%（39/48） vs. 17.5%（7/40） ,P〈 0.01 ], and longer stent implanted [ （25.0 ± 7.0） mm vs. （17.4 ± 3.4） mm,P 〈 0.01 ]. After following up for （2.2 ± 1.0） years, there were no significant differences between two groups in MACE and each component （P 〉 0.05）, however, compared with that in focal group, there was a trend of increase in MACE in non-focal group[ 22.9%（11/48） vs. 10.0%（4/40） ,P= 0.092]. Conclusion It suggests that patients with non-focal restenosis have a more severe lesion angiographically, which usually results in another DES implanted, and has a worse long-term prognosis.