老年人冠状动脉支架术后支架内再狭窄和再闭塞危险因素分析

摘要

目的 探讨老年冠状动脉(冠脉)支架术后支架内再狭窄和闭塞的危险因素. 方法 回顾性分析,选择2004年3月至2015年5月陈旧性心肌梗死冠脉狭窄和慢性完全闭塞患者131例.根据年龄将患者分为50～59岁组51例、60～69岁组43例和70～80岁组37例,分析各组不同冠脉病变所占比例特点.冠脉支架术后6个月、12个月、18个月和24个月检查患者冠脉再狭窄和闭塞情况. 结果 冠脉支架术前,合并2型糖尿病70～80岁组、60～69岁组、50～59岁组分别为27.0％(10例)、18.6％(8例)、9.8％(5例),组间比较差异有统计学意义(均P＜0.01);多支狭窄、冠脉病变长度＞20 mm、冠脉偏心性病变、冠脉重度成角病变、冠脉管壁不规则病变、冠脉近段严重弯曲、冠脉中重度钙化病变、冠脉狭窄(90～99％、100％)、冠脉复杂分叉病变发病率由高至低依次为70～80岁组、60～79岁组和50～59岁组,冠脉支架术后24个月再狭窄90％～99％分别为27.0％(10例)、18.6％(8例)、9.8％(5例),再狭窄100％分别为24.3％(9例)、14.0％(6例)、5.9％(3例),组间比较差异有统计学意义(均P ＜0.05或P＜0.01). 结果 2型糖尿病是老年冠脉复杂病变的独立预测因素.冠脉复杂病变、支架置入数和长度可能共同促使老年冠脉支架术后再狭窄和再闭塞.%Objective To investigate risk factors for in-stent restenosis and reocclusion after coronary stent implantation in aged patients.Methods 131 patients diagnosed with chronic total occlusion and old myocardial infarction due to coronary stenosis were recruited in this retrospective study from Mar 2004 to May 2015.Patients were divided into 50 to 59 years old group (n=51),60 to 69 years old group (n=43),and 70 to 80 years old group (n=37) to study coronary lesion characteristics.In-stent restenosis and reocclusion were detected at 6,12,18,and 24 months after coronary stent implantation.Results Before coronary stent implantation,the incidence rate of type 2 diabetes was significantly increased with three increasing age groups:9.8％ at ages 50-59 group (n=5),18.6％ at ages 60-69 group (n=8),and 27.0％ at ages 70-80 group (n=10) (all-P＜0.01).The incidence rates of multiple coronary artery disease,long coronary lesions (＞20 mm),eccentric coronary lesions,serious angle of coronary lesions,irregular coronary lesions,proximal coronary curvature,moderate to severe calcified coronary lesions,coronary restenosis (90％-99％ or 100％),and complex bifurcation lesions were significantly elevated with three increasing age groups (P ＜0.01 or P ＜0.05).The ratios of patients with in-stent restenosis at 24 months after coronary stent implantation were significantly elevated with three increasing age groups:at 9.8％ (n=5),18.6％ (n=8),and 27.0％(n=10) for 90％ 99％ restenosis sub-group,and at 5.9％ (n=3),14.0％ (n=6) and 24.3％ (n=9) for 100％ restenosis sub-group,respectively (all P＜0.05 or P＜0.01)Conclusions Type 2 diabetes is an independent risk factor for complex coronary lesions in aged patients Complex coronary lesions,three or more stents,and long coronary stents may lead to ir-stent restenosis and reocclusion after coronary stent implantation in aged patients.