药物洗脱支架置入术后极晚期血栓患者再发支架内血栓的临床分析  

Recurrence of stent thrombosis in patients with very late stent thrombosis after implantation of drug eluting stent

作　　者：徐立[1] 王乐丰[1] 杨新春[1] 李奎宝[1] 张大鹏[1] 王红石[1] 刘宇[1] 李惟铭[1] 孙昊[1] 倪祝华[1] 夏昆[1] 何冀芳[1] 迟永辉[1] 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,北京100020

出　　处：《中国介入心脏病学杂志》2015年第3期151-155,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的分析药物洗脱支架（drug eluting stent,DES）置入术后极晚期血栓（very late stent thrombosis,VLST）患者再次发生支架内血栓的临床情况,探讨反复发生支架内血栓可能的相关因素。方法 2006年1月到2014年2月,共完成4463例急诊冠状动脉造影,入选经造影证实为DES置入术后VLST的患者66例。根据随访期间是否再次出现支架内血栓,将患者分为再发血栓组和对照组。比较两组患者的基线资料、造影和介入治疗资料以及抗血小板药物治疗情况。分析VLST患者再次发生支架内血栓的临床特点,探讨反复发生支架内血栓可能的相关因素。结果随访0.5-90个月,共有8例（12.1%）患者再发支架内血栓,为再发血栓组;其余58例未再发支架内血栓的患者为对照组。对两组患者的性别、年龄、VLST距第一次PCI时间、VLST时AMI部位（前壁ST段抬高）、Killip心功能Ⅰ-Ⅱ级、高血压等进行单因素分析,差异均无统计学意义（均P〉0.05）。Cox单因素分析发现持续双重抗血小板治疗（dual anti-platelets therapy,DAPT）（HR 0.09,P=0.022）和再次置入第1代DES（HR 3.27,P=0.096）两项因素的P〈0.1,纳入Cox多因素分析,结果提示,坚持持续的DAPT是随访中无再发支架内血栓的唯一预测因素（HR 0.10,95%CI 0.01-0.90,P=0.04）。结论DES置入术后VLST患者可再次发生支架内血栓,值得临床重视。避免再次置入第一代DES和坚持DAPT可能有助于减少支架内血栓事件的再次发生率。Objective To study the clinical characteristics of patients with recurrence of stent thrombosis（ ST） in patients with very late stent thrombosis（ VLST） after implantation of drug eluting stent（ DES） and further investigate its possible predictens. Methods From Jan 2006 to Feb 2014,4463 emergency coronary angiography exams were performed and patients with angiographically defined VLST were enrolled. Clinical characteristics of the patients was studied. The patients were divided into two groups according to the the presence of angiography confirmed recurrence of stent thrombosis during follow up. The clinical and interventional data between the two groups were compared. Predictors for the recurrence of ST were analyzed. Results Sixty-six patients were enrolled. Angiographically defined ST reoccurred in 8patients（ 12. 1%） in 29. 6 ± 15. 7（ 0. 5- 44） months after the first VLST. There was no significant difference in the basal clinical and angiography data between the 2 groups. Cox univariate analysis showed length of dual antiplatelet treatment（ DAPT）（ HR 0. 09,P = 0. 022） and re-implantation of first generation DES（ HR 3. 27,P = 0. 096） may be possible relating factors. Multivariable Cox regression analysis revealed the only independent predictors for freedom of recurrent ST during long-term follow up was continuous DAPT at the longest available follow up（ HR 0. 10,95% CI 0. 01- 0. 90,P = 0. 04）. Conclusions Stent thrombosis could reoccur in the patients with VLST after implantation of DES. To avoid recurrence of ST,implantation of an additional first generation of DES is to be avoided,and DAPT should be continued.

关 键 词：药物洗脱支架 支架内血栓 经皮冠状动脉介入治疗 随访 

分 类 号：R541.4[医药卫生—心血管疾病]