急性ST段抬高型心肌梗死急诊经皮冠状动脉支架术后支架内再狭窄相关因素分析

Relevant factors of in-stent restenosis after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

目的:分析急性ST段抬高型心肌梗死急诊冠状动脉支架(PCI)术后支架内再狭窄相关危险因素。方法:入选我院2005年至2014年,急性ST段抬高型心肌梗死行急诊PCI病例,并因再发症状于我院复查冠状动脉造影的患者333例,男性270例(81. 1%),女性63例(18. 9%)。根据支架内狭窄是否≥50%,分为再狭窄组及无再狭窄组。记录患者的一般情况和手术情况,分析相关危险因素。结果:平均复查时间25. 04个月(中位数12个月),复查造影支架内再狭窄组132例及无再狭窄组组201 例。再狭窄组年龄小于无再狭窄组组[(56.08±10. 10)队(58.40±10.42)岁,t =-2.032,P=0.043];再狭窄组 LDL-C 高于无再狭窄组组[(3. 17±0. 81)w.( 2.95±0.82) mmol/L,t= 2.404,P = 0.017];应用球囊后扩张比例再狭窄组低于无再狭窄组组(13. 6 %% 45. 3 %,X^2 = 36. 319,P<0. 001)。多因素Logistic回归分析显示:年龄(OR= 0. 962,95%CI: 0. 934 ~ 0. 991,P = 0. 010)、CK-MB ( OR = 0. 998,95%CI: 0.996 ~1. 000,P = 0. 033)及使用球囊后扩张(OR= 0. 139,95%CI:0. 068-0. 284,P<0. 001)减少支架内再狭窄的发生,糖尿病病史(OR= 1.902,95%CI: 1.036?3.492,P<0. 038)增加支架内再狭窄的危险。结论:急性 ST段抬高型心肌梗死患者,急诊PCI术中行球囊后扩张术支架内再狭窄率较低,且明显降低支架内再狭窄风险。同时糖尿病病史显著增加支架内再狭窄危险。

Objective: To investigate the risk factors of in-stent restenosis in patients with acute ST- segment elevation myocardial infarction after emergency percutaneous coronary intervention ( PCI). Methods : 333 patients Recurrent symptoms with acute ST-segment elevation myocardial infarction who underwent emer-gency PCI from 2005 to 2014 were enrolled in our hospital, 270 males ( 81. 1%) and 63 females ( 18. 9%) were reexamined by coronary angiography. Stenosis was divided into restenosis group and no restenosis group ac-cording to whether stenosis in stent was more than 50%. Record the general situation of patients and surgical conditions, use multivariate Logistic analysis to analyze the related risk factors. Results: The average time of reexamination was 25. 04 months(Median 12 months). 132 cases in restenosis group and 201 cases in no rest-enosis group. The age of restenosis group was younger than that of no restenosis group [( 56. 08± 10. 10)vs.(58. 40±10. 42) years old, t =-2. 032, P=0. 043];the LDL-C of restenosis group was higher than that of no restenosis group [(3. 17±0. 81)vs.(2. 95±0. 82)mmol/L,t= 2. 404,P = 0. 017];the proportion of dilatation after balloon was lower than that of no restenosis group ( 13. 6% vs. 45. 3%, X^2 = 36. 319, P<0. 001).Multiple Logistic regression analysis showed that age ( OR = 0. 962,95% CI: 0. 934 - 0. 991, P = 0. 010 ) CK-MB ( OR = 0. 998,95%CI: 0. 996 -1. 000, P = 0. 033) after balloon (OR = 0. 139, 95% CI: 0. 068 - 0. 284, P< 0. 001) Reduction of in-stent restenosis, History of diabetes mellitus( OR= 1. 902,95%CI:1. 036-3. 492,P<0. 038) In-creased risk of in-stent restenosis. Conclusions: In acute ST-segment elevation myocardial infarction, the rate of in-stent restenosis after balloon dilatation in emergency PCI is low, and the risk of in-stent restenosis is sig-nificantly reduced. Meanwhile, the history of diabetes significantly increased the risk of in-stent restenosis.