斑块组成对晚期药物支架贴壁不良影响的虚拟组织学血管内超声研究

Effect of plaque compositions on LSM after drug-eluting stent implantation:A virtual histology study on IVUS

目的探讨基线斑块组成对药物洗脱支架（drug—elutingstent，DES）置入术后晚期支架贴壁不良（1atestentmalapposition，LsM）的影响。方法入选不稳定性心绞痛患者76例（113处病变）行冠状动脉原位病变DES置入及基线和随访虚拟组织学血管内超声检查，分为LSM组11例和无LSM组65例。结果11例患者有16处（14．2％）病变，随访时发现LSM。不同DES比较，差异无统计学意义（P〉0．05）。LSM组糖尿病（63．6％us29．2％，P〈0．05）、支架长度[（29．4±5．5）mmvs（26．2士6．0）mm，P〈0．051、坏死核心体积[（29．8士14．0）mm3 vs （21．4±9．5）mm3，P〈0．01]及坏死核心体积百分比[（26．5±6．6）％VS（20．1土6．6）％，P〈0．01]均明显高于无LSM组。多因素回归分析显示，坏死核心体积百分比（OR=1．144，95％CI：1．052～1．243，P=0．002）和糖尿病（OR=3．829，95％CI：1．158～12．663，P=0．028）是LSM的独立预测因素。结论病变坏死核心成分和糖尿病与不稳定性心绞痛DEs置入术后LSM形成有关。

Objective To study the effect of plaque compositions on late stent malapposition （I.SM） after drug-eluting stent implantation. Methods Seventy-six patients with unstable angina pectoris （113 lesions） were included in this study. The patients underwent in situ drug-eluting stent implantation,bseline and virtual histology IVUS. The patients were divided into LSM （n= 11） and non-LSM group （n=65）. Results Sixteen lesions were found in 11 patients （14.2%） during the follow-up. No significant difference was observed in drug-eluting stent between the two groups （P〉0.05）. The incidence of diabetes mellitus was higher,the stent was longer,the necrot- ic core volume was larger,and the necrotic core percentage was higher in LSM group than in non- LSM group （63.6% vs 29.2%,P〈0.05;29.4±5.5 mm vs 26.2±6.0 mm,P〈0.05%29.8±14. 0 mm3 vs 21.4±9.5 mma,P〈0. 01 ;26.5% ±6.6% vs 20.1% ±6.6%,P〈0.01）. Multivariate regression analysis showed that necrotic core volume,necrotic core percentage and diabetes mellitus were the independent predictors for LSM （OR ： 1. 144,95 % CI ： 1. 052-1. 243, P= 0. 002 ; OR = 3. 829,95%CI：1. 158--12. 663,P=0. 028）. Conclusion Necrotic core compositions and diabetes mellitus are related with LSM in patients with unstable angina pectoris after drug-eluting stent implantation.