植入雷帕霉素药物支架长度对围手术期心肌梗死的预测研究  

The Relationship of Implanted Sirolimus Drug Eluting Stent Length to the Risk of Perioperative Myocadial Infarction

作　　者：楼建英[1] 何静[2] 王达理[1] 张必利[2] 张伟[1] 

机构地区：[1]解放军第454医院心内科,江苏南京210002 [2]第二军医大学长海医院心内科,上海200433

出　　处：《现代生物医学进展》2010年第2期284-286,382,共4页Progress in Modern Biomedicine

摘　　要：目的:评估植入支架长度对围手术期心肌梗死的预测意义。方法:选择2005年6月到2009年2月解放军第454医院医院及长海医院341名冠心病患者,共植入351枚雷帕霉素药物支架,根据植入支架数目分为单个支架组(22-36mm)及重叠支架组(>36mm);根据植入支架长度分四组:①28-36mm②37-59mm③60-80mm④>80mm。观察支架植入后的急性并发症,术后心电图变化和术后1周内心肌肌钙蛋白的变化。结果:1.手术成功率达98.9%,急性并发症发生率为6.1%。住院期间主要不良心血管事件(MACE)发生率达到14.1%。2.根据植入单个支架组与重叠支架组比较,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%VS1.1%,P<0.05;而在住院期间MACE发生率上前者也明显高于后者:11.6%VS5.6%,P<0.05。3.在支架长度分组中发现支架长度>60mm组发生围手术期并发症及MACE事件明显高于28-36mm组,P<0.05;其余组间未见显著差异。结论:重叠支架植入方法及植入支架长度>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 risk of implanted sirolimus drug eluting stent length to perioperative myocadial infarction. Methods：We evaluated procedural success,periprocedure and major in-hospital myocadial injuryand complications in 341 consecutive patients（354 native coronary lesions） . According to implantion methods,patients are devided into 2 groups with using a single long stent（22-36mm） or overlapping stent（36mm） .And according to length of the stent implantion,patients are devided into 4 groups：① 28-36mm ② 37-59mm ③60-80mm ④80mm. The success rate,the complications during PCI and MACE during hospitalization were observed. Results：The procedural success rate was 98.6%. The overall in hospital complication is 6.1%;MACE occurred during hospitalization reached 14.1%,and TNI level after PCI in overlapping stent group（ 36 mm） was significantly higher than that of single stent group（ 22-36mm） ：6.0% VS 1.1%,P 0.05,and it was higher that MACE in hospital on the former than the latter：11.6% VS 5.6%. Perioperative myocadial injury and MACE of stent length 60 mm group were significantly higher than 28-36 mm group. The other groups were no significant difference. Conclusions：The overlapped SES method and the implanted stent length over 60mm was associated with higher risk of perioperative myocadial infarction.

关 键 词：雷帕霉素药物支架 围手术期心肌梗死 肌钙蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]