急性冠状动脉综合征是支架内再狭窄的常见表现

Acute coronary syndrome is a common clinical manifestation of in-stent restenosis

目的 探讨支架内再狭窄的常见表现。方法 1996～ 2 0 0 2年之间接受了经皮冠状动脉 (冠脉 )介入治疗 4 31例患者进行了重复冠脉造影 ,连续 2 36例发生自体血管再狭窄 ,支架内再狭窄(Ⅰ组 ) 188例 ,非支架再狭窄 (Ⅱ组 ) 4 8例 ,早期急性支架内血栓形成除外。与非支架再狭窄对比分析支架内再狭窄的临床表现。结果 心肌缺血再发的平均时间Ⅰ组和Ⅱ组差异无显著性 (5 3个月比6 1个月 ,P >0 0 5 ) ,休息心绞痛 (Braunwald 2和 3级 ,4 3%比 2 7% ,P <0 0 5 )、休息心绞痛 +急性心肌梗死 (6 4 %比 4 3% ,P <0 0 5 )和血管造影可视血栓发生率 (7 4 %比 0 % ,P <0 0 5 )Ⅰ组明显多于Ⅱ组。结论 急性冠脉综合征是再狭窄的常见临床表现 ,支架内再狭窄病人较非支架再狭窄更常见。

Objective To study the common clinical manifestations of in-stent restenosis.Methods Of 431 patients who underwent percutaneous coronary intervention and repeat catheterization between January 1, 1996 and December 31, 2002, 236 consecutive patients with recurrent ischemia and restenosis were identified: 188 patients with ( groupⅠ) and 48 without (groupⅡ) stenting. Patients who developed early acute stent thrombosis were excluded from the study. In the study we compared the clinical manifestations of in-stent restenosis with those of restenosis without stenting.Results Recurrent clinical ischemia occurred at a mean of 5.3 months in group Ⅰ and 6.1 months in groupⅡ ( P >0.05). Rest angina (Braunwald class 2 and 3, 43% vs 27%, P <0.05) , the combination of rest angina and acute myocardial infarction (43% vs 27%, P <0.05), and angiographically visible thrombosis (7% vs 0%, P <0.05 ) were more frequent in groupⅠ than in group Ⅱ.Conclusion Acute coronary syndromes are the common clinical manifestations of restenosis in patients undergoing percutaneous coronary intervention and occur more frequently in patients with in-stent stenosis than in those with restenosis without stenting.