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目的:了解置入药物洗脱支架(DES)患者在经皮冠状动脉(冠脉)介入治疗(PCI)术后各期支架血栓(ST)的发生情况,并与置入金属裸支架(BMS)患者进行比较,探讨影响支架血栓发生的危险因素。方法:连续入选2001-07至2002-06和2003-07至2005-06期间接受PCI并置入支架的所有患者,共入选3893例。随访至少2年。根据所使用支架分为DES组(n=2930,至少置入1枚DES)和BMS组(n=963,单纯置入BMS)。记录所有患者住院期和随访期内临床资料,并根据美国和欧洲学者组成的学术研究联盟(ARC)正式发表的支架血栓定义判定支架血栓事件。结果:与BMS组相比,DES组患者的平均年龄较大,而白细胞数、甘油三脂水平和空腹血糖水平较低,既往有冠脉血运重建病史者较多,但吸烟、糖尿病和ST段抬高型心肌梗死(STEMI)发生率较低;在DES组患者的冠脉病变中,多支病变、开口病变、前降支(LAD)近段病变和左主干(LM)病变发生率较高,但慢性完全闭塞性(CTO)病变所占的发生率较低,造影成功率及完全血运重建率均较高,差异均有统计学意义(P均<0.05～0.001)。两组患者PCI术后无论在住院期还是之后的随访期内,所有的不良心脑血管事件发生率均无显著差异,而支架血栓发生率在急性期、亚急性期、晚期和晚晚期均无差异(P均>0.05)。Cox回归分析结果提示,DES组患者发生支架血栓的危险因素为:氯吡格雷疗程短和冠脉多支病变(P均<0.001);而BMS组患者发生支架血栓的危险因素为:血清肌酐值升高和合并高血压(P均<0.05)。结论:尽管DES时代患者的病变更为复杂,所置入的DES数更多,但支架血栓的发生率并不比BMS时代更高。但术后双联抗血小板治疗的疗程过短和冠脉多支病变是支架血栓发生的危险因素,应引起重视。
Objective: To investigate the incidence of stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) after stent implantation in patients undergoing DES (DES) Patients were compared to explore the risk factors for stent thrombosis. METHODS: All patients who underwent PCI and were placed in stents between 2001-07 and 2002-06 and 2003-07 to 2005-06 were enrolled in a total of 3893 patients. Follow up for at least 2 years. According to the stent used, the patients were divided into DES group (n = 2930, at least 1 DES) and BMS group (n = 963, BMS alone). The clinical data of all patients during the hospitalization and follow-up were recorded, and the stent thrombosis was judged according to the published definition of stent thrombosis by the Academic Research Consortium (ARC) composed of American and European scholars. Results: Compared with BMS group, the average age of patients in DES group was relatively large, while the number of white blood cells, triglyceride and fasting blood glucose were lower. There was a history of prior coronary revascularization, but smoking, diabetes and ST The incidence of segmental elevated myocardial infarction (STEMI) was lower in patients with coronary artery disease in the DES group, multiple lesions, open lesions, proximal anterior descending artery (LAD) and left main lesion (LM) High, but the incidence of chronic total occlusion (CTO) lesions was lower, the success rate of imaging and complete revascularization were higher, the difference was statistically significant (P <0.05 ~ 0.001). There was no significant difference in incidence of all adverse cardiovascular and cerebrovascular events between the two groups after PCI both in hospitalization and after follow-up, while the incidence of stent thrombosis in acute phase, subacute phase, late phase and late phase had no significant difference Difference (all P> 0.05). The results of Cox regression analysis showed that the risk factors for stent thrombosis in DES group were clopidogrel short course and multiple coronary artery disease (all P <0.001), while the risk factors for stent thrombosis in BMS group were serum creatinine Hypertension and hypertension (all P <0.05). CONCLUSIONS: Despite the more complex lesions and the greater number of DES implanted in DES-era patients, the incidence of stent thrombosis was not higher than in the BMS era. However, double-antiplatelet therapy after treatment is too short and coronary artery disease is a risk factor for stent thrombosis, should pay attention.