药物洗脱支架内再狭窄再次置入支架的远期疗效和安全性

摘要

目的：探讨对药物洗脱支架（ DES）置入后发生再狭窄（ ISR）患者再次实施DES置入术的远期疗效和安全性。方法选择植入DES的冠心病患者，经冠状动脉造影检查证实发生再狭窄（ ISR≥50％），并且再次置入DES治疗ISR介入手术成功的患者。985例DES-ISR患者根据狭窄类型分为局限性狭窄组130例（13 p．2％），弥漫性狭窄组699例（71．0％），闭塞性狭窄组156例（15．8％）。随访观察3组患者的远期（6个月、12个月）疗效及安全性。结果经过6个月的随访，局限性狭窄组患者主要不良心血管事件（MACE）的发生率为3．85％（5/130）；弥漫性狭窄组患者MACE的发生率为2．72％（19/699）；闭塞狭窄组患者MACE的发生率为3．21％（5/156），3组6个月的随访结果差异无统计学意义（ P ＞0．05）。经过12个月的随访，局限性狭窄组患者MACE的发生率为13．08％（17/130）；弥漫性狭窄组患者MACE的发生率为9．16％（64/699）；闭塞狭窄组患者MACE的发生率为9．62％（15/156），3组12个月的随访结果差异亦无统计学意义（ P ＞0．05）。结论目前对于DES-ISR患者来说，不论ISR的类型，再次置入DES都是一种有效的方法。%Objective To observe the long-term safety and efficacy of drug eluting stent ( DES) implantation reste-nosis ( ISR) patients're-implementation of DES implantation .Methods Selected DES implantation in patients with coronary heart disease , coronary angiography examination confirmed the occurrence of restenosis ( ISR≥50%) , and once again in the DES intervention ISR operation successful patients .985 cases of DES ISR patients according to narrow type were divided into localized stenosis group with 130 cases (13.2%), diffuse stenosis group with 699 cases (71.0%), occlusive stenosis group with 156 cases (15.8%).Long term follow-up observation of efficacy and safety in the 3 groups (6 months, 12 months). Results After 6 months of follow-up, localized stenosis group with major adverse cardiovascular events ( MACE) occurred in 3.85%(5/130);in diffuse stenosis group, the incidence of MACE was 2.72%(19/699);in occlusion stenosis group, the incidence of MACE was 3.21%(5/156), no statistically significant of 6 month follow-up were found among 3 groups ( P >0.05).After 12 months of follow-up, localized stenosis groups'incidence of MACE was 13.08%(17/130);in diffuse steno-sis group, the incidence of MACE was 9.16%(64/699); in occlusion stenosis group , the incidence of MACE was 9.62%(15/156), the follow-up results of 3 groups of 12 months had no statistical difference significance ( P >0.05).Conclusion It demonstrated that the re-implementation DES implantation was an effective alternative for treatment of DES ISR .