曲美他嗪在预防冠状动脉支架置入后再狭窄的作用及其机制探讨

The effect of trimetazidine in the prevention of restenosis after coronary stent implantation

目的:探讨曲美他嗪维持治疗在预防冠状动脉支架置入后再狭窄(ISR)的效果。方法:随机选取2012年6月至2015年6月,入住我院且需要行经皮冠状动脉介入治疗的患者。经皮冠状动脉介入治疗和支架置入后,一部分患者给予1个月的曲美他嗪维持治疗,另一部分患者不给予曲美他嗪治疗。支架置入后12个月,冠状动脉造影检测血管的再狭窄情况。结果:此次研究共有507例患者参与,治疗组249例,对照组258例。在治疗后12个月的观察期中,对照组有29例患者出现了心脑主要不良事件,而治疗组有15例患者出现心脑主要不良事件。冠状动脉造影的结果显示共有37例患者出现了ISR,约占患者总数的7.3%,其中对照组为26例(10.1%),治疗组为11例(4.4%)。研究发现年龄、吸烟、糖尿病、支架的长度和支架的直径均与ISR的发生紧密相关(P<0.05)。曲美他嗪治疗具有更低的ISR风险,是独立的保护因素(P<0.05)。结论:曲美他嗪维持治疗能有效的预防冠状动脉ISR的发生,我们的研究为临床用药提供了理论指导。

Objective： To study the effect of trimetazidine maintenance therapy in the prevention of restenosis after coronary stent implantation. Methods： The patients need for percutaneous coronary intervention（ PCI） were randomly selected from June 2012 to June 2015 in our hospital. After PCI and stenting,some patients were given a month＇s trimetazidine maintenance treatment; some patients did not give any trimetazidine treatment. Coronary angiography was used to detect vascular restenosis 12 months after stent implantation. Results： This study enrolled a total of 507 patients,249 in treatment group and 258 in control group. In the posttreatment observation period of 12 months,29 patients in the control group had major adverse cardiac events,while the treatment group had 15 patients with major adverse cardiac events. The coronary angiographyresult showed that a total of 37 patients had in-stent restenosis（ 7. 3%）,including 26 in the control group（ 10. 1%）and 11 in the treatment group. In addition,our study also found that age,smoking,diabetes,length and diameter of the stent were associated with the occurrence of in-stent restenosis（ P〈0. 05）. Trimetazidine treatment with a lower risk of restenosis after stenting,is an independent protective factor（ P〈0. 05）. Conclusion： Trimetazidine maintenance treatment can effectively prevent restenosis after coronary stent implantation; our study provides a theoretical guidance for clinic use.