冠状血管病变特征对支架术后再狭窄的预测价值

Predictive value of clinical influence on angiographic in-stent restenosis after coronary stent placement

目的 :探讨冠状血管病变特征对支架术后再狭窄的影响。方法 :冠状动脉造影 (CAG)随访支架术后患者共 110例 ,定量 (QCA)分析术前、术后即刻和随访时靶血管造影结果 ;比较支架术前靶血管及患者临床资料 ,应用单因素和多因素回归法分析术前靶血管解剖学和临床危险因素与再狭窄的相关性。结果 :再狭窄组中术前甘油三酯有增高趋势 ,但与无再狭窄组比较差异无显著性意义 (P >0 .0 5 )。单因素分析表明 ,再狭窄组血管术前狭窄程度、靶血管最小管腔直径和病变分型与无再狭窄组比较差异显著 (P <0 .0 5 ) ;多因素逐步回归分析表明 ,术前靶血管最小管腔直径和病变分型是再狭窄形成的独立危险因素 ,其OR值分别为 0 .12 0和 2 .6 4 2。结论 :冠状血管病变特征对支架术后再狭窄具重要预测价值。

Objective:To evaluate the predictive value of clinical influence on 6 month clinical and angiographic in stent restenosis after coronary stent placement.Methods:Patients who underwent successful coronary stenting were taken reangiography during 6 month follow up period. (Because larger part of patients in our study had recurrence of angina with less part of patients remained angina free, so we had much higher in stent restenosis than it actually had). Clinical (age, gender, coronary risk factors, serum levels of lipids and lipoprotein), quantitative angiographic (lesion localization, morphology, pre and postangioplastic minimal lumen diameter, reference diameter, and percent diameter stenosis), together with the clinical performance of unstable angina and its risk classification were analyzed by univariate and multivariate logistic regression analysis.Results:On the basis of preprocedual angiography, 110 patients with a total of 141 lesions received stent placement. At 6 months follow up, 67 patients ( 60.9 %) with 83 lesions ( 58.8 %) developed in stent restenosis as checked by coronary angiography. Multivariate analysis revealed minimal lumen diameter and AHA/ACC lesion type preprocedural to be independently associated with in stent restenosis during follow up periods. (OR: 0.120 and 2.642 ).Conclusion:Angiographic anatomy of coronary lesion preprocudural is associated with in stent restenosis, while minimal lumen diameter and AHA/ACC lesion type are two independently factors in evaluating the prognostic of stent placement.