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目的比较冠心病患者弥漫病变采用药物洗脱支架和金属裸支架治疗的近期和远期预后,分析影响这类病变介入治疗预后的危险因素。方法研究对象为我院2004年4月至2005年8月接受置入单个长度>25.0mm支架治疗并且进行冠状动脉造影随访的205例患者,排除支架置入失败及支架置入位置不理想者。分为置入药物洗脱支架(DES)组(n=128)和置入金属裸支架(BMS)组(n=77)。所有的患者术后均接受阿司匹林300mg、氯吡格雷75mg等规范药物治疗。手术成功判定标准为至少用相互垂直的两个投照体位行冠状动脉造影,肉眼判定残余狭窄<20%和前向血流TIMI3级。再狭窄判定标准以复查冠状动脉造影定量分析支架内或支架邻近血管管腔直径狭窄程度≥50%。患者在支架术后6个月左右接受冠状动脉造影随访。结果共205例患者(男性181例,女性24例)227个靶病变置入382枚支架完成造影随访。其中C型病变占总数的93.8%,B2型病变为6.2%。双支或双支以上血管病变的患者比例达到86.8%。平均术前参考血管直径(2.88±0.43)mm。平均每个病变支架长度(40.09±12.94)mm,54.2%的病变接受了重叠置入支架。比较置入DES组和置入BMS组,两组的患者基本条件差异无统计学意义,在病变基本条件方面,DES组术前参考血管直径明显小于BMS组[(2.80±0.37)mm比(3.10±0.48)mm,P=0.005]。6个月随访结果显示再狭窄率DES组(15.4%)小于BMS组(48.4%),P<0.001。晚期支架内腔径丢失BMS组明显大于DES组[(0.94±0.76)mm比(0.39±0.53)mm,P<0.001]。靶病变血管重建率DES要明显好于BMS(11.6%比38.5%,P<0.001)。支架内再狭窄在置入DES组的局限性再狭窄比例大于置入BMS组(33.3%比18.2%,P=0.029)。对影响复杂弥漫病变支架再狭窄因素的多元logistic回归分析发现,采用支架重叠置入(OR=2.82,P=0.017)和支架类型(OR=5.71,P<0.001)是对复杂弥漫病变支架内再狭窄影响最大的危险因素。结论我们的研究发现对于复杂弥漫病变的治疗,药物洗脱支架有着良好的治疗效果,较金属裸支架能明显减低再狭窄率。对于弥漫病变,我们应该使用长支架,尽可能减少支架重叠置入的数量。
Objective To compare the short-term and long-term prognosis of diffuse lesions in patients with coronary heart disease treated with drug-eluting stents and bare metal stents and to analyze the risk factors that influence the prognosis of these lesions. Methods The study was performed in 205 patients with single stent> 25.0mm in our hospital from April 2004 to August 2005 and followed up by coronary angiography. Excluding unsuccessful stent placement and unsuitable stent placement. Divided into drug-eluting stent (DES) group (n = 128) and metal-bare stent (BMS) group (n = 77). All patients received aspirin 300mg, clopidogrel 75mg and other standard drugs after surgery. The criteria for successful surgery were line angiography with at least two shots perpendicular to each other and gross residual stenosis <20% and forward flow TIMI grade 3. Criteria for the determination of restenosis Coronary angiography to review the quantitative analysis of stents or stents adjacent to the vessel lumen diameter stenosis ≥ 50%. Patients underwent coronary angiography 6 months after stenting. Results A total of 227 target lesions were placed in 382 stents in 205 patients (181 males and 24 females). Type C lesions accounted for 93.8% of the total, type B2 lesions was 6.2%. The proportion of patients with double-vessel or double-vessel vascular disease reached 86.8%. Mean preoperative reference vessel diameter (2.88 ± 0.43) mm. On average, the length of each stent was (40.09 ± 12.94) mm, and 54.2% of the lesions received overlapping stent placement. Compared with the BMS group, there was no significant difference in basic conditions between the two groups (P> 0.05). The preoperative baseline diameter of the DES group was significantly lower than that of the BMS group [(2.80 ± 0.37) mm vs 3.10 ± 0.48) mm, P = 0.005]. The 6-month follow-up results showed that the restenosis rate was lower in the DES group (15.4%) than in the BMS group (48.4%), P <0.001. The loss of lumen diameter in the late stents was significantly greater in the BMS group than in the DES group (0.94 ± 0.76 mm vs 0.39 ± 0.53 mm, P <0.001). Target lesion revascularization rate DES was significantly better than BMS (11.6% vs. 38.5%, P <0.001). The proportion of in-stent restenosis in the DES group was greater than that in the BMS group (33.3% vs 18.2%, P = 0.029). Multivariate logistic regression analysis of the factors influencing stent restenosis in complex diffuse lesions found that the use of overlapping stent placement (OR = 2.82, P = 0.017) and stent type (OR = 5.71, P <0.001) Narrow the most influential risk factors. Conclusions Our study found that drug-eluting stents have a good therapeutic effect on the treatment of complex diffuse lesions and significantly reduce the rate of restenosis compared to bare metal stents. For diffuse lesions, we should use long brackets to minimize the number of overlapping braces.