国产雷帕霉素长支架临床应用与疗效评价  

Periprocedural and late consequences after percutaneous coronary interventions using long domestic sirolimus drug eluting stents

作　　者：何静[1] 刘博[1] 张必利[1] 王可[1] 王妍妍[1] 秦永文[1] 

机构地区：[1]第二军医大学附属长海医院心内科,上海市200433

出　　处：《中国心血管病研究》2009年第2期84-87,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的评价国产雷帕霉素长支架对弥漫性长病变的疗效与安全性。方法选择2006年6月至2008年2月长海医院347例冠心病患者，并根据置入支架数目分组为单个支架组（22-36mm）及重叠支架组（〉36mm）；根据置人支架长度分4组：22-36mm、37-59mm、60-80him和〉80mm组。观察支架置入后对分支血管的即刻影响、术后心电图变化和术后1周内心肌肌钙蛋白的变化，并且随访术后的临床症状和主要不良心血管事件（MACE）。结果①总的手术成功率达98．9％，总的急性并发症发生率为6．1％。住院期间MACE发生率达14．1％，30d内MACE发生率5．4％。②重叠支架组（〉36mm）术后肌钙蛋白I（TNI）显著高于单个支架组（22-36mm）：6．0％比1．1％（P〈O．05）；住院期间MACE发生率也明显高于单个支架组：11．6％比5．6％（P〈0．05）；30d内MACE发生率差异无统计学意义。③支架长度〉60mm组发生围手术期并发症及MACE事件明显高于22-36mm组（P〈0．05），其余组问差异无统计学意义。结论国产雷帕霉素药物支架治疗弥漫性长病变即刻及近期疗效可靠、安全。重叠支架组及置入支架长度〉60mm明显增加术后心肌损伤标志物释放，增加围手术期非Q波心肌梗死的发生率及住院期间MACE事件发生率。Objective To evaluate the clinical and angiographie outcomes of domestic sirolimus drug eluting stents（SES） implantation over a very long coronary artery segment. Methods We evaluated procedural success, periprocedure and major in-hospital complications and short-term （30 days） clinical outcomes in 341 consecutive patients （354 native coronary lesions ）. According to implantation methods, patients were divided into 2 groups with using a single long stent （22-36 mm）or overlapping stent （〉36 mm）. According to length of the stent implantation, patients were divided into 4 groups：（1）28-36 mm,（2）37-59 mm,（3）60-80 mm,and （4）〉80 mm. The success rate, the complications during PCI, MACE during hospitalization and within 30 days were observed. Results The procedural success rate was 98.6%. The overall complication in hospital was 6.1%. MACE occurred during hospitalization reached 14.1% ,and major adverse cardiovascular events to 30 days reached 5.4%. Compared with CYPHER stent, there showed no significant differences （P〈0.05）.TNI level after PCI in overlapping stent group（〉 36 mm） was significantly higher than that of single stent group（22-36 mm） （6.0% vs 1.1%,P〈0.05）, and it was higher that MACE in hospital in the former than the latter （11.6% vs 5.6%）. Both of MACE to 30 days has no significant difference. Perioperative complications and MACE of stent length 〉60 mm group were significantly higher than 22-36 mm group. The other groups were no significant difference. Conclusion SES implantation is safe and effective for de novo coronary lesions requiring multiple stent placement over a very long vessel segment. Overlapped SES is associated with an increase of the myocardial damage markers during periprocedure,and the stent length is positive correlation with the MACE in hospital.

关 键 词：雷帕霉素 药物支架 围术期并发症 

分 类 号：R541.4[医药卫生—心血管疾病]