急性心肌梗死患者药物洗脱支架植入后光学相干层析成像研究

Assessment of vascular healing with optical coherence tomography in patients with acute myocardial infarction after receiving drug-eluting stent implantation

目的采用光学相干层析成像(OCT)技术观察急性心肌梗死(AMI)患者药物洗脱支架(DES)植入1年后血管内膜增生及支架小梁覆盖程度,并与稳定型心绞痛(SA)患者作比较。方法入选2011年3月至2012年7月因冠心病接受DES植入术治疗患者39例,其中AMI患者16例,SA患者23例。术后1年复查冠状动脉造影和OCT检查,测定新生内膜厚度、面积、容积、支架小梁覆盖及贴壁比率。结果 OCT测定结果显示,AMI组与SA组相比,平均新生内膜厚度(66.8 mm±20.7 mm对121.6 mm±135.7 mm,P=0.022)、新生内膜容量比率(5.66%±3.18%对11.88%±8.22%,P=0.005)、新生内膜>100μm截面数比率(22.56%±23.99%对40.14%±30.01%,P=0.034)和支架小梁总体覆盖率(93.42%±7.03%对89.27%±6.40%,P=0.007)均明显较低。结论 AMI患者植入DES后内膜修复情况不佳,内膜增生及支架小梁覆盖率较差。

Objective By using optical coherence tomography（OCT） to evaluate the vascular neointimal hyperplasia and the stent strut coverage degree in patients with acute myocardial infarction（AMI）and in patients with stable angina（SA） one year after receiving drug- eluting stent（DES） implantation, and to compare the clinical results between the two groups. Methods A total of 39 patients, who received DES implantation due to coronary heart disease, including AMI（n=16, AMI group） and SA（n=23, SA group）,during the period from March 2011 to July 2012, were enrolled in this study. One year after DES implantation, coronary angiography and OCT reexaminations were performed in all patients. The neointimal hyperplasia（NIH） thickness, NIH area, NIH volume, strut coverage and apposition rate were determined with OCT. The results were compared between the two groups. Results OCT measuring results showed that the mean NIH thickness of AMI group and SA group was（ 66. 8 ± 20. 7） mm and（ 121. 6 ± 135. 7） mm respectively（P=0.022）; the NIH volume ratio were 5.66%±3.18% and 11.88%±8.22% respectively（P=0.005）; the percentage of cross- section with NIH thickness over 100 μm was 22.56%±23.99% and 40.14%±30.01% respectively（P =0.034）; and the percentage of overall stent strut coverage was 89.27% ±6.40% and93.42% ±7.03% respectively（P =0.007）. All the above mentioned data of AMI group were obviously lower than those of SA group. Conclusion After DES implantation, the intimal repair, intimal hyperplasia and stent strut coverage in AMI patients are poorer.