经皮冠状动脉介入治疗术后急性、亚急性支架内血栓形成的危险因素分析

摘要

目的:探讨经皮冠状动脉(冠脉)介入治疗(PCI)后急性、亚急性支架内血栓形成(AST/SST)的危险因素及其冠脉造影特点,以早期识别高危患者并减少该并发症的发生.方法:回顾性分析2007- 01至2011- 01收治的冠心病行PCI术者5 129例的临床资料,其中冠脉造影证实AST/SST(AST/SST组)43例.按年龄、性别(3∶1)匹配原则抽取PCI术后未出现AST/SST者120例作为对照组.采用logistic回归模型分析AST/SST的独立危险因素.结果:AST/SST平均时间(4.1±5.7)d.院内死亡率13.95%(6/43).AST/SST组糖尿病比例及血肌酐、空腹血糖高于对照组(P<0.05);AST/SST组支架置入前1周内心绞痛发作及1个月内急性心肌梗死史比例均高于对照组(P<0.05、<0.01),差异均有统计学意义.左心室射血分数、血压、血脂等各项指标差异均无统计学意义.冠脉造影AST/SST组出现B2/C病变比例、支架贴壁不良比例和支架数目均高于对照组,差异均有统计学意义(P<0.05~0.01).应用条件logistic回归分析确定PCI术后AST/SST的独立危险因素:糖尿病(比值比1.447,95%可信区间1.101~1.902,P=0.008)、急性心肌梗死(比值比7.177,95%可信区间1.956~26.328,P=0.003)、多支架置入(比值比2.186,95%可信区间1.326~3.604,P=0.002)、支架贴壁不良(比值比7.590,95%可信区间1.389~41.475,P=0.019)是AST/SST的独立危险因素,高左心室射血分数(比值比0.988,95%可信区间0.979~0.998,P=0.016)是PCI术后并发AST/SST的保护因素(P均<0.05).结论:糖尿病、急性心肌梗死、多支架置入、支架贴壁不良是PCI术后并发AST/SST的独立危险因素.高左心室射血分数是PCI术后并发AST/SST的保护因素.%Objective:To analyze the risk factor of acute/sub-acute stent thrombosis( AST/SST )in patients after percutaneous coronary intervention( PCI )in order to identify the high risk patients at early stage and to reduce such complication.rnMethods:We retrospectively reviewed 5129 coronary artery disease( CAD )patients undergoing PCI who admitted in our hospital from 2007 to 2011. Our work included 2 groups. AST/SST group,n = 43 ,the patients with coronary angiography( CAG )con-firmed lesions,and Control group, n= 120, the patients with matched age and gender( 3 : 1 ),and the patients had no AST/SST after PCI. Logistic regression analysis was performed to identify the independent risk factors of AST/SST.rnResults:AST/SST occurred at a median of( 4. 1±5. 7 )days after symptom onset,the in hospital mortality was 13. 95%( 6/ 43 ). Compared with Control group, AST/SST group had more diabetes mellitus,higher serum creatinine and fasting blood surger, all P<0. 05. The occurrence of angina and AMI at 1 week and 1 month before stent implantation were higher in AST/SST group,P <0. 05 and P<0. 01. Left ventricular ejection fraction( LVEF ),blood pressure and blood lipids were similar in both groups,P> 0. 05. CAG presented that AST/SST group had more B2/C lesion,stent mal-apposition and stent number,P<0. 05 ～0. 01. Logistic regression analysis indicated that the independent risk factors for AST/SST included diabetes mellitus( OR: 1.447,95% CI:rn1. 101 ～1.902,P = 0.008 ),AMI( OR:7. 177,95% CI: 1. 956 ～26. 328,P = 0. 003 ),more stent nuraber( OR:2. 186,95% CI: 1.326～3.604,P = 0.002)and stent mal-apposition( OR:7. 590,95% CI:1. 389 ～ 41.475,P = 0.019 ). High LVEF is a protective factor for AST/SST( OR:0. 988,95% CI:0. 979 ～0. 998 ,P=0. 016 )occurrence after PCI.rnConclusion: Diabetes mellitus, AMI, more stent number, stent mal-apposition are independent risk factors for AST/SST occurrence in CAD patients after PCI treatment. High LVEF is a protective factor for AST/SST complication.