晚期/极晚期支架内血栓与支架内再狭窄患者的临床特征及相关因素分析

Clinical Characteristics and Related Factors of Late/Very Late Stent Thrombosis and In-stent Restenosis

目的:探索晚期/极晚期支架内血栓与支架内再狭窄患者在临床表现、冠状动脉造影及介入治疗等方面的关联与特征.方法:研究连续入选367例患者,包括70例冠状动脉造影证实明确/可能的晚期/极晚期支架内血栓患者(支架内血栓组)和297例冠状动脉造影证实支架内再狭窄患者(支架内再狭窄组).所有患者均在本院接受罪犯病变置入支架手术且再次入院接受相应靶病变的治疗.收集患者的资料,并进一步分析两类患者的特征.结果:与支架内再狭窄组患者相比,支架内血栓组患者主要表现为ST段抬高型心肌梗死,有更高比例的陈旧性心肌梗死患者和有停服抗血小板药物病史的患者,且介入治疗次数更多,住院时间更长(P均<0.05).两组间绝大多数的基线和介入治疗特征的差异无统计学意义(P均>0.05).多因素分析显示,更高水平的中性粒细胞/淋巴细胞比值(NLR)、N末端B型利钠肽原(NT-proBNP)>300 pg/ml与晚期/极晚期支架内血栓发生独立相关.结论:NT-proBNP、NLR与晚期/极晚期支架内血栓发生独立相关.

Objectives: To explore the clinical features and relazed factors of late/very late stent thrombosis (ST) and in stent restenosis (ISR). Methods: A total of 367 consecutive patients including 70 patients with coronary angiography confirmed definite/ probable late/very late ST and 297 patients with coronary angiography confirmed ISR were included in this study. All patients received initial culprit vessel stenting and were treated in our hospital due to ST or ISR according to current guidelines. Characteristics were compared and analyzed between patients with ST or ISR. Results: Prevalence of old myocardial infarction, history of discontinued anti-platelet medication, and the frequencies of PCI were significantly higher, and the hospital stay was significantly longer in late/very late ST patients than in ISR patients. Most baseline and procedural characteristics were similar between ST and ISR patients. Multivariable analysis showed that higher levels of neutrophil to lymphocyte(NLR) and NT-proBNP were independently associated with the late/very late ST. Conclusions: Higher NT-proBNP and NLR could be used aspotential independent predictorsand biomarkers for risk stratification of late/very late ST.