结合OCT分析DES术后晚期或晚晚期支架内血栓形成的危险因素

Risk factors of late and very late in-stent thrombosis in patients after drug-eluting stents implantation

目的：结合光学相干断层成像技术（OCT）分析药物洗脱支架（DES）术后支架内晚期或晚晚期血栓发生的危险因素。方法：回顾性分析曾在本院或外院行药物支架术,经冠状动脉（冠脉）造影和（或）OCT确诊的发生晚期或晚晚期支架内血栓的19例患者。按年龄、性别（2∶1）匹配原则抽取曾行药物支架术,冠脉造影证实未发生支架内血栓患者38例作为对照组。对晚期或晚晚期支架内血栓的主要危险因素、冠脉造影和OCT分析。采用条件Logistic回归分析晚期或晚晚期支架内血栓形成的独立危险因素。结果：支架内血栓组糖尿病史、既往心肌梗死病史、空腹血糖、左室射血分数（LVEF）与对照组差异有统计学意义（均P〈0.01）。定量冠脉造影分析及OCT检查结果显示：支架内血栓组患者置入支架数目、支架长度、支架贴壁不良率、支架内皮未被覆盖率均显著高于对照组（P〈0.05）。条件Logistic回归分析显示：既往心肌梗死病史（OR：7.642,95%CI：1.412~41.152,P〈0.01）、支架长度（OR：13.285,95%CI：3.198~55.189,P〈0.01）、支架数量（OR：1.645,95%CI：1.106~2.447,P=0.014）、支架贴壁不良率（OR：5.132,95%CI：4.800~5.464,P=0.001）、未被覆盖支架柱比例（OR：12.549,95%CI：3.657~43.067,P〈0.01）、糖尿病（OR：7.256,95%CI：1.721~30.591,P〈0.01）为DES术后晚期或晚晚期血栓的危险因素。正常的LVEF（OR：0.714,95%CI：0.574~0.887,P=0.002）为其保护因素。结论：长支架、多支架置入、支架贴壁不良和支架内皮化不全、心肌梗死病史是晚期或晚晚期血栓的独立危险因素,正常的LVEF是其保护因素。

Objective： To analysis the risk factors of late and very late in-stent thrombosis in patients after drug-eluting stents implantation by optical coherence tomography. Method： We retrospctively reviewed patients undergoing PCI who admitted in our hospital. Nineteen patient were diagnosied LST or VLST by coronary angiog- raphy and/or OCT which named ST group. The patients with matched age and gender （2 ： 1） 38 patients had no in-stent thrombosis as control group （CL group）. Their clinical, coronary angiography and OCT data were recor- ded and an Excel database was established to analysis the major control lable risk factors of LST and VLST. Lo- gistic regression analysis was performed to identify the independent risk factors of LST and VLST. Result： Com- pared with CL group, ST group had more diabetes mellitus （DM）, AMI and higher fasting blood surge, lower LVEF （all P〈0.01）. CAG and OCT showed that ST group had more stent numbers, stent length, mal-apposi- tion and uncovered struts. Logistic regression analysis indicated that the independent risk factors of LST and VLST were DM （OR： 7. 256, 95%C/： 1. 721-30. 591, P〈0.01）, AMI （OR： 7. 642, 95%CI： 1. 412-41. 152, P〈0.01）, stent number （OR： 1. 645, 95% CI： 1. 106-2. 447, P=0. 014）, stent length （OR： 13. 285, 95% CI： 3. 198-55. 189, P〈0.01）, stent mal-apposition （OR： 5. 132, 95%CI： 4. 800-5. 464, P=0. 001）, stent strut uncovered （OR： 12. 549, 95%CI： 3. 657-43. 067, P〈0.01）. Normal LVEF was a protective factor for LST and VLST （OR： 0. 714, 95% CI： 0. 574 - 0. 887, P = 0. 002）. Conclusion： DM, AMI, more stent number, longer stent, stent mal-apposition, stent strut uncovered are risk factors of late and very late in-stent thrombosis in patients after drug-eluting stents implantation. Normal LVEF is protective factor for LST or VLST.