冠状动脉内支架植入术后再狭窄的危险因素和预测

Predictors and risk factors of restenosis after coronary stenting

目的 回顾性分析冠状动脉支架植入术后再狭窄发生的危险因素。方法 自 1993年 7月至 2 0 0 0年 5月我院共行选择性冠状动脉支架植入术 15 46例 ,对进行了冠状动脉造影随访的 12 5例资料进行了分析 ,冠状动脉病变狭窄程度及长度用定量冠状动脉造影分析 ,统计学采用Logistic多因素逐步回归分析。结果 12 5例患者在 16 0处病变植入支架。冠状动脉造影显示支架内再狭窄 (狭窄直径≥ 5 0 % ) 6 1例、6 8处病变 ,无再狭窄 6 4例、92处病变。多因素逐步回归分析显示再狭窄与术前甘油三酯浓度、术前狭窄程度和术后残余狭窄呈显著正相关 ,其比数比 (OR)分别为 1 5 89,1 0 89和1 6 6 5 ;与术前参考血管直径和在梗塞相关动脉植入支架呈负相关 ,OR分别为 0 2 6 2和 0 114。结论冠状动脉支架植入术后再狭窄与甘油三酯浓度、术后残余狭窄与狭窄程度呈显著正相关 ,术前参考血管直径和狭窄程度呈显著负相关 ,参考血管直径越小 ,甘油三酯浓度越高 ,残余狭窄越重 ,再狭窄发生率越高 ;而梗塞相关动脉支架植入术后不易发生再狭窄 ;对支架植入术患者尽量减少术后残余狭窄是减少再狭窄的重要环节。

Objective To analyse the risk factors and predictors of restenosis after coronary stenting in Chinese patients. Methods From July 1993 to May 1999 selective coronary stenting was performed in 1 546 cases in this institution, among them follow up coronary angiography was undergone in 125 patients due to exertional chest pain, atypical chest discomfort or doctor′s advise. The stenosis and length of the lesions were measured by QCA. Logistic regression was used for statistical analysis. Results Of the 125 patients, stents were implanted in 160 lesions. Follow up coronary angiography revealed that instent restenosis defined by vessel diameter stenosis ≥50% developed in 68 lesions of the 61 patients. Single variable analysis showed that restenosis correlated with triglyceride before procedure, stenosis before procedure, residual stenosis following stenting, vessel reference diameter before and after procedure, minimal luminal diameter before procedure, stents diameter and infarct related artery (IRA). Logistic regression analysis revealed that there were positive correlation, between triglyceride before procedure ( OR = 1.589), stenosis before procedure ( OR = 1.089), residual stenosis immediate following stenting ( OR = 1.665) and restenosis; and negative correlation between IRA stenting ( OR = 0.114), reference diameter before porcedure ( OR = 0.262) and restenosis. Conclusion Residual stenosis following procedure, vessel reference diameter, triglyceride and severity of stenosis before procedure are strong predictors of restenosis after coronary stenting in Chinese patients, and restenosis is less seen in IRA than in non IRA, which is not reported in the literatures. To reduce residual stenosis during procedure may significantly reduce restenosis.