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目的回顾性分析经皮冠状动脉支架植入术后复查冠状动脉造影患者冠状动脉支架内再狭窄(in-stent restenosis,ISR)的相关危险因素。方法纳入2007年1月至2015年5月在遵义医学院附属医院心内科住院行冠状动脉支架植入术并于术后8~12个月随访行冠状动脉造影的患者1 136例,其中男性835例,女性301例,年龄(61.61±12.32)岁。根据随访造影结果支架相关病变血管是否狭窄及程度将其分成ISR组(n=72)和非ISR组(n=1 064),记录两组患者的心血管危险因素、临床合并症、用药情况以及介入治疗相关参数等,分析可能导致ISR的相关因素。结果本组病例资料造影随访显示ISR发生率为6.3%。与非ISR组比较,ISR组患者在吸烟、糖尿病、血脂异常、高血压、术后服药依从性差、长病变和多支病变、支架直径和长度及最小管腔直径(MLD)等方面差异具有统计学意义(P<0.05)。长期规律服用阿司匹林、氯吡格雷和大剂量他汀类患者的比例,在非ISR组与ISR组比较差异亦具有统计学意义(P<0.05)。结论冠状动脉支架植入术后再狭窄是临床多因素共同作用结果,与未控制的心血管危险因素、抗血小板治疗和他汀治疗依从性以及支架治疗病变特征相关。
Objective To retrospectively analyze the related risk factors of in-stent restenosis (ISR) after coronary stent implantation in patients undergoing coronary angiography. Methods From January 2007 to May 2015, 1 136 patients were enrolled in Department of Cardiology, Affiliated Hospital of Zunyi Medical College to coronary stent implantation and were followed up for 8-12 months postoperatively, of whom 835 Cases, 301 cases of women, age (61.61 ± 12.32) years old. According to the results of follow-up angiography, whether the stenosis-related vessels were stenosed and divided into ISR group (n = 72) and non-ISR group (n = 1064), the cardiovascular risk factors, clinical complications, Interventional treatment related parameters, analysis of factors that may lead to ISR. Results The follow-up of angiographic data showed that the incidence of ISR was 6.3%. Patients in the ISR group had statistically significant differences in smoking, diabetes, dyslipidemia, hypertension, poor postoperative medication compliance, long and multiple lesions, stent diameter and length, and minimal lumen diameter (MLD) compared with non-ISR patients Significance (P <0.05). Long-term regular use of aspirin, clopidogrel and high-dose statin patients in the proportion of non-ISR group and ISR difference was also statistically significant (P <0.05). Conclusions Restenosis after coronary stenting is a multifactorial clinical outcome associated with uncontrolled cardiovascular risk factors, compliance with antiplatelet and statin therapy, and stenting characteristics.