药物洗脱支架置入术后晚期支架内再狭窄患者再次介入治疗的短期预后及危险因素分析

Short-term Outcomes and Prognostic Risk Factors of Late Drug-eluting Stent Restenosis Patients Undergoing Repeated Percutaneous Coronary Intervention

目的:本研究旨在探索老龄和非老龄药物洗脱支架置入术后晚期支架内再狭窄(L-ISR)患者的临床特征,再次经皮冠状动脉介入治疗(PCI)后的短期预后及相关危险因素。方法:共入选218例在我院初次置入药物洗脱支架并于2016年因L-ISR而需要再次入院接受治疗的患者。根据患者年龄分为老龄组(年龄≥65岁,n=77)和非老龄组(年龄<65岁,n=141)。患者的入院特征、临床表现以及介入治疗特点和手术结果等被纳入分析评估,并随访患者PCI后12个月内的主要不良心血管事件(MACE)包括心原性死亡、非致死性心肌梗死及靶病变血运重建(TLR)。结果:L-ISR患者中75.7%的患者因不稳定性心绞痛入院,64.7%的患者再次置入支架。与非老龄组相比,老龄组有更高比例的脑卒中、心房颤动、既往冠状动脉旁路移植术并且支架置入至发现支架内再狭窄的时间更长,体重指数(BMI)更小、冠心病家族史比例更低(P均<0.05)。两组患者入院时的临床症状表现相似,主要表现为不稳定性心绞痛,其他基线资料比较差异均无统计学意义(P均>0.05)。与老龄组患者相比,非老龄组患者的MACE发生率较高,但差异无统计学意义(6.4%vs 3.9%,P=0.546)。多因素回归分析发现,左心室收缩功能障碍(OR=6.317,95%CI:1.145~34.843, P=0.034)是L-ISR患者介入治疗后短期MACE发生的独立危险因素。结论:左心室收缩功能障碍与L-ISR患者短期MACE发生相关。在临床实践中,识别该类人群可能更有助于L-ISR患者的危险分层和二级预防。

Objectives: To explore the clinical characteristics of senile and non-senile patients with late in stent restenosis(L-ISR) and analyze the short term outcomes and related risk factors after repeat percutaneous coronary intervention(PCI).Methods: A total of 218 L-ISR patients undergoing repeat PCI in 2016 in our department were included in this analysis. Patients were categorized as senile group(age ≥65 years;n=77) and non-senile group(age<65 years;n=141). Associations between clinical characteristics and outcomes after PCI were evaluated. Primary composite endpoint of major adverse cardiac events(MACE) including cardiac death, non-fatal myocardial infarction, or target lesion revascularization(TLR) within 12 months after re-PCI were followed. Results: Of the L-ISR patients, 75.7% were hospitalized due to unstable angina pectoris and 64.7% patients received repeat stent implantation. Incidence of stroke, atrial fibrillation, previous coronary artery bypass grafting was significantly higher, time between first PCI to ISR was significantly longer, while body mass index(BMI) and family history of coronary heart disease were lower in the senile group than in the non-senile group(all P <0.05). The clinical symptoms of the two groups at admission were similar, mainly manifested as unstable angina pectoris. The incidence of MACE(6.4% vs 3.9%, P=0.546) was also similar between the two groups. Multivariate analysis showed that left ventricular systolic dysfunction(OR=6.317, 95% CI: 1.145-34.843, P=0.034) was the independent predictor for MACE during short-term follow up among L-ISR patients.Conclusions: Left ventricular systolic dysfunction is associated with worse short-term outcome in L-ISR patients. The results may contribute to the risk stratification and secondary prevention of L-ISR patients in clinical practice.