药物洗脱支架置入后早期冠状动脉支架内血栓的危险因素分析

Risk factors analysis for early coronary stent thrombosis after drug eluting stent implantation

目的探讨药物洗脱支架(DES)置入后发生早期支架内血栓(EST)的危险因素。方法河北省沧州市中心医院2008—2018年行DES置入的患者共有20 518例,回顾性选取97例明确EST患者为EST组,按照年龄、性别和危险因素相近似的原则,选取194例患者为对照组。分析两组患者的临床和围术期资料,并应用logistic回归分析评估EST的危险因素。结果 DES置入术后EST的发生率为0.5%(107/20 518),病死率为23.4%(25/107)。291例患者中,男性127例(43.6%),年龄18～80岁,平均年龄为(68.1±8.2)岁。两组的糖尿病、高三酰甘油血症、高纤维蛋白原、ST段抬高型急性冠状动脉综合征、弥漫病变、小血管病变、多枚支架串联、支架≥30 mm、第二代药物涂层支架、未高压后扩张及使用血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂等均有显著差异(均为P<0.05)。多因素logistic回归分析发现,高三酰甘油血症、弥漫病变、小血管病变、多枚支架串联、支架长度≥30 mm、未应用第二代药物涂层支架、未高压后扩张是EST的危险因素(均为P<0.05),其中直径≤2.75 mm的小血管病变是最强的预测因素(OR=6.37,95%CI:2.51～11.86)。结论 EST有多种危险因素,需规范介入操作及加强围术期抗栓治疗,尤其是小血管及弥漫病变需要多枚支架串联的患者,应选用第二代药物涂层支架,且行高压后扩张,防止支架贴壁不良,减少EST的发生。

Objective To explore the risk factors for early stent thrombosis(EST)after drugeluting stent(DES)implantation.Methods A cohort of 20 518 patients who underwent DES implantation in Cangzhou Central Hospital from 2008 to 2018 were retrospectively enrolled.97 patients with EST were in the EST group and according to the principle of age,gender and risk factors,194 cases without EST were selected as the control group.Clinical data and coronary lesions characteristics were compared between the two groups.Multivariate logistic regression analysis was used to evaluate risk factors for EST.Results The incidence of EST after DES was 0.5%(107/20 518),and the mortality was 23.4%(25/107).Of 291 patients enrolled,there were 127 males(43.6%),with a mean age of(68.1±8.2)years.Multiple logistic regression analysis showed that hypertriglyceridemia,diffuse lesion,small vessel lesion,multiple stent series,the stent≥30 mm,no second generation DES and no high pressure expansion were risk factors for EST(all P<0.05).Moreover,the small vessel lesion≤2.75 mm was the most strongest risk factor(OR=6.37,95%CI:2.51-11.86).Conclusions For patients with risk factors of EST,standardized intervention and enhanced perioperative antithrombotic therapy should be performed,especially for those with small blood vessels and diffuse lesions requiring more stents implanted,thus the second generation DES,and high pressure expansion should be performed to prevent stent malapposition,and reduce the occurrence of EST.