冠状动脉慢性完全闭塞病变和非慢性完全闭塞病变置入西罗莫司洗脱支架再狭窄的临床研究

In-stent restenosis in coronary chronic total occlusion lesion and non chronic total occlusion after implantation with sirolimus drug-eluting stent

目的 评价冠状动脉慢性完全闭塞病变（CTO）和非CTO病变对西罗莫司（雷帕霉素）洗脱支架（SES）置入1年后支架内再狭窄（ISR）的影响,并分析ISR的预测因素.方法 选取2012年1月1日至2013年12月30日置入SES并于1年后回福建医科大学附属龙岩市第一医院心内科复查冠状动脉造影患者357例,根据冠状动脉置入支架前有无完全闭塞和闭塞时间≥3个月分为CTO组80例和非CTO组277例,比较两组患者的临床特征,并采用logistic回归分析评价各变量与ISR的相关性.结果 CTO组患者的年龄[（59.7±9.2）岁比（63.0±9.6）岁,P=0.007]、射血分数[（56.3±11.2）％比（61.3±10.6）％,P=0.000]、非顺应性球囊高压后扩张所占比例[12例（15.0％）比73例（26.4％）,P=0.036]均显著低于非CTO组,ISR发生率显著高于非CTO组[18例（22.5％）比36例（13.0％）,P =0.037],差异均有统计学意义.多因素logistic逐步回归分析显示,支架置入后非顺应性球囊高压后扩张是患者支架置入1年后ISR的保护因素（OR0.345,95％ CI0.136～0.874,P=0.015）.结论 CTO病变较非CTO病变可能增加支架置入1年后的ISR发生率,支架置入后非顺应性球囊高压后扩张是患者支架置入1年后ISR的保护因素.

Objective To investigate if coronary chronic total occlusion （CTO） lesions increased in-stent restenosis （ISR） in 12 months after sirolimus-eluting stent （SES） implantation.Methods 357 consecutive patients implanted with sirolimus-eluting stent （SES） from January 2012 to December 2013 were enrolled.The patients were catagonied according to angiography finding as chronic total occlusion lesions （n =80） and non-occlusion lesions （n =277）.The clinical characteristics were compared between the two groups.Results Patients with CTO lesions were found to have younger age [（59.7 ± 9.2） yrs vs.（63.0 ±9.6） yrs,P =0.007],lower EF [（56.3 ± 11.2）％ vs.（61.3 ± 10.6）％,P =0.000] and fewer cases had post dilation [12 cases （15.0％） vs.73 cases （26.4％）,P =0.036].The rate of ISR was higher in the CTO group [18 cases （22.5％） vs.36 cases （13.0％）,P =0.037].Multivariate logistic regression study showed non-compliant balloon post dilation was the protective factor of ISR within 1 year （OR O.345,95％ CI 0.136-0.874,P =0.015）.Conclusions Coronary chronic total occlusion lesions increases the rates of in-stent restenosis.