支架植入一个月后再发急性心肌梗死原因分析  

Analysis of acute myocardial infarction one month after stent implantation

作　　者：宋光远[1] 高立建[1] 杨跃进[1] 徐波[2] 高润霖[1] 李建军[1] 乔树宾[1] 秦学文[1] 刘海波[1] 姚民[1] 袁晋青[1] 戴军[1] 尤士杰[1] 裴汉军[1] 赵振燕[1] 王喜梅[1] 吴永健[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院冠心病诊疗中心,100037 [2]中国医学科学院北京协和医学院介入中治疗心,100037

出　　处：《中华内科杂志》2009年第10期814-817,共4页Chinese Journal of Internal Medicine

摘　　要：目的探讨支架植入1个月后发生急性ST段抬高心肌梗死（STEAMI）原因。方法2005—2007年连续入选192例支架植入1个月后再发STEAMI行急诊经皮冠状动脉介入术（PCI）治疗患者，如靶病变位于支架两侧边缘5mH／内为晚发血栓，否则为新生病变破裂。结果192例STEAMI中新生病变破裂144例（75％），晚发血栓48例（25％）。从PCI后到发生STEAMI时间分别为（30．1±12．4）个月和（20．3±11．9）个月（P〈0．001）。多元logistic回归分析晁示两组中糖尿病和药物洗脱支架（DES）更容易发生晚发血栓（HR分别为3．387，95％CI 1．053～10．898和HR5．311，95％ CI 1．066～26．464，P〈0．05）。结论支架植入1个月后发生STEAM[主要由于新生病变破裂所致，糖尿病和植入DES患者史容易发生晚期血栓，这两类患者可能需延长抗血小板治疗。Objective To study the possible causes of ST-elevated acute myocardial infarction （STEAMI） occurring one month after percutancous coronary intervention （PCI）. Methods One hundred and ninety two patients aged from 40-79 years who had a successful previous PCI and also received primary PCI clue to STEAMI in this hospitalization were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and the acute results of last PCI, etc. were recorded in detail. If the AMI-related lesion was localized in-stents or at the edge of stents （ distanee from the edge ≤ 5 mm） , it was defined aslate thrombosis, otherwise it was regarded as an AMI induced by new-leslon. Results New lesions, as the cause of STEAMI, were found in 144 cases （Group A, 75% ） , and late thrombosis in 48 patients （Group B, 25% ）. There was a significant difference in the average time from previous PCI to AMI （30. 1± 12.4 vs. 20. 3 ± 11.9 months） between the two groups. Diabetes mellitus （DM） and drug-elutlng stents （DES） utilization were associated with markedly higher morbidity of late thrombosis in adjusted logistic regressionanalysis [ hazard ratio （HR） 3. 387, 95% CI 1. 053-10. 898 and HR 5. 311, 95% CI 1. 066-26. 464]. Conclusions STEAMI occurred 1 month after PCI arc more likely to be developed from previous insignificant lesions than from late thrombosis in stents. Moreover, DM and DES are associated with a high ineidence of late thrombosis, which may indicate that intensive antiplatelet therapy should he considered in diabetic patients receiving PCI.

关 键 词：药物洗脱支架 心肌梗死 血栓形成 

分 类 号：R686[医药卫生—骨科学]