药物洗脱支架置入术后再发支架内血栓患者的危险因素分析
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摘要
目的:分析药物洗脱支架(DES)置入术后再发支架内血栓(rST)患者的临床资料,探讨其危险因素。方法:入选2013年1月至2016年12月间,经冠状动脉造影证实的支架内血栓患者84例,随访0.5~56个月,将期间再次发生支架内血栓的患者11例作为实验组(rST组),余73例患者作为对照组。采用COX回归分析两组患者的基线资料、两次造影和介入治疗情况,筛选rST的危险因素。结果:单因素分析显示:阿司匹林治疗后血小板高反应性(P=0.091)以及再次置入第一代DES(P=0.011)这两项参数的P值<0.1,纳入COX多因素回归,确定再次置入第一代DES是rST的危险因素(RR=5.828,95%CI=1.091~31.117,P=0.039)。结论:支架内血栓复发率高,再次置入第一代DES是rST的危险因素,阿司匹林治疗后血小板高反应性增加再发血栓的风险。
Objective: To analyze the related risk factors of recurrent stent thrombosis( rST) in patients who underwent drug eluting stent( DES) implantation. Methods: From January 2013 to December 2016,84 patients with angiographically confirmed coronary stent thrombosis were enrolled. 11 patients who suffered from recurrent stent thrombosis were included in experiment group after follow-up for 0. 5 to 56 months,while the remaining 73 cases who had no rST at the same time served as control group. COX regression analysis was performed to identify the independent risk factors of rST. Result : COX univariate analysis showed that high onaspirin treatment platelet reactivity( P = 0. 091) and re-implantation of first generation DES( P = 0. 011) might be correlated with rST. Multivariable analysis by Cox regression indicated that the independent risk factor for rST was re-implantation of first generation DES( RR = 5. 828,95% CI = 1. 091 ~ 31. 117,P = 0. 039). Conclusion:Stent thrombosis is one of the common complications following DES implantation with high recurrence. The present study revealed that re-implantation of first generation DES was the independent risk factor for rST,while high on-aspirin treatment platelet reactivity was related to increased risks.
Objective: To analyze the related risk factors of recurrent stent thrombosis( rST) in patients who underwent drug eluting stent( DES) implantation. Methods: From January 2013 to December 2016,84 patients with angiographically confirmed coronary stent thrombosis were enrolled. 11 patients who suffered from recurrent stent thrombosis were included in experiment group after follow-up for 0. 5 to 56 months,while the remaining 73 cases who had no rST at the same time served as control group. COX regression analysis was performed to identify the independent risk factors of rST. Result : COX univariate analysis showed that high onaspirin treatment platelet reactivity( P = 0. 091) and re-implantation of first generation DES( P = 0. 011) might be correlated with rST. Multivariable analysis by Cox regression indicated that the independent risk factor for rST was re-implantation of first generation DES( RR = 5. 828,95% CI = 1. 091 ~ 31. 117,P = 0. 039). Conclusion:Stent thrombosis is one of the common complications following DES implantation with high recurrence. The present study revealed that re-implantation of first generation DES was the independent risk factor for rST,while high on-aspirin treatment platelet reactivity was related to increased risks.
引文
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[11]Bonello L,Tantry U S,Marcucci R,et al.Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate[J].J Am Coll Cardiol,2010,56(12):919-933.
[12]Lee S H,Kim B K,Oh J,et al.Successful prasugrel rescue therapy in clopidogrel resistant patients who had recurrent stent thrombosis of drug-eluting-stent:the role of prasugrel in clopidogrel nonresponders[J].Korean Circ J,2013,43(5):343-346.
[13]Kim Y S,Lee S R.Successful prasugrel therapy for recurrent left main stent thrombosis in a clopidogrel hyporesponder[J].Tex Heart Inst J,2015,42(5):483-486.
[14]Lee Y H,Yang H M,Tahk S J,et al.Recurrent stent thrombosis in a patient with antiphospholipid syndrome and dual antiplatelet therapy non-responsiveness[J].Korean Circ J,2015,45(1):71-76.
[15]Hovens M M,Snoep J D,Eikenboom J C,et al.Prevalence of persistent platelet reactivity despite use of aspirin:a systematic review[J].Am Heart J,2007,153(2):175-181.
[16]Stuckey T D,Kirtane A J,Brodie B R,et al.Impact of Aspirin and Clopidogrel Hyporesponsiveness in Patients Treated With Drug-Eluting Stents:2-Year Results of a Prospective,Multicenter Registry Study[J].JACC Cardiovasc Interv,2017,10(16):1607-1617.
[17]Mayer K,Bernlochner I,Braun S,et al.Aspirin treatment and outcomes after percutaneous coronary intervention:results of the ISARASPI registry[J].J Am Coll Cardiol,2014,64(9):863-871.
[18]Kotani J,Awata M,Nanto S,et al.Incomplete neointimal coverage of sirolimus-eluting stents:angioscopic findings[J].J Am Coll Cardiol,2006,47(10):2108-2111.
[19]欧阳墉,欧阳雪晖,张学军,等.新一代药物洗脱支架及其抗血栓形成的作用[J].介入放射学杂志,2014(05):369-375.
[20]Lange R A,Hillis L D.Second-generation drug-eluting coronary stents[J].N Engl J Med,2010,362(18):1728-1730.
[21]胡江乔,宋现涛,贾博.雷帕霉素与CD34抗体联合支架系统的安全有效性研究[J].心肺血管病杂志,2014,33(6):795-798.
[2]Nakazawa G.Stent thrombosis of drug eluting stent:pathological perspective[J].J Cardiol,2011,58(2):84-91.
[3]Kimura T,Morimoto T,Kozuma K,et al.Comparisons of baseline demographics,clinical presentation,and long-term outcome among patients with early,late,and very late stent thrombosis of sirolimus-eluting stents:Observations from the Registry of Stent Thrombosis for Review and Reevaluation(RESTART)[J].Circulation,2010,122(1):52-61.
[4]Genereux P,Stone G W,Harrington R A,et al.Impact of intraprocedural stent thrombosis during percutaneous coronary intervention:insights from the CHAMPION PHOENIX Trial(Clinical Trial Comparing Cangrelor to Clopidogrel Standard of Care Therapy in Subjects Who Require Percutaneous Coronary Intervention)[J].J Am Coll Cardiol,2014,63(7):619-629.
[5]Almalla M,Schroder J,Hennings V,et al.Long-term outcome after angiographically proven coronary stent thrombosis[J].Am J Cardiol,2013,111(9):1289-1294.
[6]Porto I,Burzotta F,Parma A,et al.Angiographic predictors of recurrent stent thrombosis(from the Outcome of PCI for stentThrombos Is Mult Icentre STudy[OPTIMIST])[J].Am J Cardiol,2010,105(12):1710-1715.
[7]Armstrong E J,Sab S,Singh G D,et al.Predictors and outcomes of recurrent stent thrombosis:results from a multicenter registry[J].JACC Cardiovasc Interv,2014,7(10):1105-1113.
[8]van Werkum J W,Heestermans A A,de Korte F I,et al.Longterm clinical outcome after a first angiographically confirmed coronary stent thrombosis:an analysis of 431 cases[J].Circulation,2009,119(6):828-834.
[9]Cutlip D E,Windecker S,Mehran R,et al.Clinical end points in coronary stent trials:a case for standardized definitions[J].Circulation,2007,115(17):2344-2351.
[10]Chadha D S,Sumana B,Karthikeyan G,et al.Prevalence of aspirin resistance in Asian-Indian patients with stable coronary artery disease[J].Catheter Cardiovasc Interv,2016,88(4):E126-E131.
[11]Bonello L,Tantry U S,Marcucci R,et al.Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate[J].J Am Coll Cardiol,2010,56(12):919-933.
[12]Lee S H,Kim B K,Oh J,et al.Successful prasugrel rescue therapy in clopidogrel resistant patients who had recurrent stent thrombosis of drug-eluting-stent:the role of prasugrel in clopidogrel nonresponders[J].Korean Circ J,2013,43(5):343-346.
[13]Kim Y S,Lee S R.Successful prasugrel therapy for recurrent left main stent thrombosis in a clopidogrel hyporesponder[J].Tex Heart Inst J,2015,42(5):483-486.
[14]Lee Y H,Yang H M,Tahk S J,et al.Recurrent stent thrombosis in a patient with antiphospholipid syndrome and dual antiplatelet therapy non-responsiveness[J].Korean Circ J,2015,45(1):71-76.
[15]Hovens M M,Snoep J D,Eikenboom J C,et al.Prevalence of persistent platelet reactivity despite use of aspirin:a systematic review[J].Am Heart J,2007,153(2):175-181.
[16]Stuckey T D,Kirtane A J,Brodie B R,et al.Impact of Aspirin and Clopidogrel Hyporesponsiveness in Patients Treated With Drug-Eluting Stents:2-Year Results of a Prospective,Multicenter Registry Study[J].JACC Cardiovasc Interv,2017,10(16):1607-1617.
[17]Mayer K,Bernlochner I,Braun S,et al.Aspirin treatment and outcomes after percutaneous coronary intervention:results of the ISARASPI registry[J].J Am Coll Cardiol,2014,64(9):863-871.
[18]Kotani J,Awata M,Nanto S,et al.Incomplete neointimal coverage of sirolimus-eluting stents:angioscopic findings[J].J Am Coll Cardiol,2006,47(10):2108-2111.
[19]欧阳墉,欧阳雪晖,张学军,等.新一代药物洗脱支架及其抗血栓形成的作用[J].介入放射学杂志,2014(05):369-375.
[20]Lange R A,Hillis L D.Second-generation drug-eluting coronary stents[J].N Engl J Med,2010,362(18):1728-1730.
[21]胡江乔,宋现涛,贾博.雷帕霉素与CD34抗体联合支架系统的安全有效性研究[J].心肺血管病杂志,2014,33(6):795-798.
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