极晚期支架内血栓与支架内再狭窄患者的临床对比分析

Clinical Comparison Between Very-late Stent Thrombosis and Very-late In-stent Restenosis

目的:对比分析极晚期支架内血栓(VLST)与极晚期支架内再狭窄患者的临床特点,探讨VLST的潜在临床危险因素。方法:入选因急性冠状动脉综合征(ACS)入院并经冠状动脉造影证实VLST的患者共21例,另外入选同时期行冠状动脉造影证实极晚期支架内再狭窄的ACS患者共38例作为对照组。比较两组的基线资料、临床检验及检查资料,行Logistic回归分析探讨VLST的危险因素。结果:(1)VLST组有8例(38.1%)近1个月自行停用抗血小板药物,对照组有5例(13.2%),两组比较差异有统计学意义(P=0.03)。(2)VLST组有13例(61.9%)以ST段抬高型心肌梗死(STEMI)为表现,而对照组均以非ST段抬高急性冠状动脉综合征(NST-ACS)为表现(100%),两组差异有统计学意义(P<0.001)。(3)两组间年龄、性别、既往高血压、糖尿病、心肌梗死病史、吸烟史及既往介入病史等差异均无统计学意义(P>0.05)。(4)与对照组比较,VLST组左心室射血分数(LVEF)显著降低(P=0.001);肌钙蛋白I(Tn I)峰值、N末端B型利钠肽原(NT-pro BNP)峰值均显著升高(P<0.001);白细胞总数及超敏C反应蛋白(hs-CRP)水平也显著升高,差异均有统计学意义(P<0.001)。(5)两组间超声心动结构、血脂、血糖、肌酐等代谢指标差异无统计学意义(P>0.05)。(6)Logistic分析表明,停用抗血小板药物、较高的NT-pro BNP及hs-CRP水平是VLST的独立危险因素(P<0.05)。结论:VLST临床表现危重,坚持抗血小板治疗、改善心功能可能有助于减少其发生。

Objective：To compare the clinical features between very late stent thrombosis（VLST） and very late in-stent restenosis,to discuss the potential risk factors for VLST occurrence.Methods：Our research included in 2 groups：VLST group,21 ACS patients with coronary angiography（CAG） confirmed VLST admitted in our hospital and Control group,38 ACS patients with CAG confirmed very late in-stent restenosis at same period of time.Basic clinical data,laboratory tests and relevant examinations were compared between 2 groups;potential risk factors for VLST occurrence were studied by Logistic regression analysis.Results：（1） There were 8（38.1%） patients discontinued anti-platelet therapy in a month by themselves in VLST group and 5（13.2%） in Control group,P=0.03.（2） 13（61.9%） patients presented as ST-segment elevation myocardial infarction（STEMI） in VLST group,while all（100%） patients presented as Non-ST-segment elevation ACS（NST-ACS） in Control group,P0.001.（3） The age,gender,previous histories of hypertension,diabetes,MI,smoking and interventional therapy were similar between 2 groups,P 〈0.05.（4） Compared with Control group,VLST group had decreased LVEF,P =0.001,increased peak values of Tn I and NT-pro BNP,elevated WBC and hs-CRP,all P〈0.001.（5） The index of echocardiography,blood lipid profiles,glucose and creatinine were similar between 2 groups,P〈0.05.（6） Logistic regression analysis showed that discontinued anti-platelet therapy,elevated NT-pro BNP and hs-CRP were the independent risk factors for VLSToccurrence,P〈0.05.Conclusion：VLST may have life-threatening clinical features,insisted anti-platelet therapy and improved cardiac function could reduce VLST occurrence.