冠状动脉支架内血栓患者长期随访不良事件的预测因素分析

米杰; 张春晓; 孙中华; 钟明惠; 田刚; 黄平; 臧希文; 陈涛; 樊瑞娟; 齐向前

doi:10.13201/j.issn.1001-1439.2014.07.014

冠状动脉支架内血栓患者长期随访不良事件的预测因素分析

- 1 天津医科大学心血管病临床学院, 泰达国际心血管病医院内二科(天津, 300457);
- 2 胜利油田中心医院心内科

详细信息

通讯作者: 齐向前,E-mail:qixq@tedaich.com

中图分类号: R541.4

收稿日期: 2014-03-03

Predictors of major adverse cardiac events after long-term follow up in angiographically confirmed coronary stent thrombosis

- 1 Department of Cardiology, Clinic Cardiology College of Tianjin Medical University, TEDA International Cardiovascular Hospital, Tianjin, 300457, China;
- 2 Department of Cardiology, Shengli Oilfield Central Hospital

More Information

Corresponding author: QI Xiangqian, E-mail: qixq@tedaich.com

Received Date: 03 March 2014

摘要

摘要: 目的:通过对支架内血栓 (stent thrombosis, ST) 患者的长期随访, 分析主要不良心血管事件 (MACE) 的发生率及其预测因素。方法:本研究连续入选2005-01-2012-09在我中心经冠状动脉造影明确诊断的ST患者。收集患者既往病史 (2型糖尿病、高血压、陈旧性心肌梗死)、冠心病家族史、吸烟史、左室射血分数、血脂及肾功能水平、ST分型 (早期、晚期和超晚期ST)、介入诊治经过 (是否应用血栓抽吸、主动脉内球囊反搏、血小板Ⅱb/Ⅲa受体拮抗剂、再次植入支架、再次植入同一种类药物涂层支架以及术后TIMI血流等)、住院及随访期间的抗血小板、他汀类和血管转换酶抑制剂等药物治疗方案。记录患者住院及随访期间MACE (包括心源性死亡、再发明确的ST、非致死性心肌梗死以及靶血管重建等)。通过单因素分析及Cox回归分析确定MACE的预测因素。结果:54例ST患者入选, 其中5例 (9.3%) 住院期间死亡, 其余49例平均随访 (48.1±25.1) 个月, 最短16个月, 最长107个月。住院期间、1年、2年、3年、4年和5年的MACE发生率分别为14.8%、16.7%、20.7%、25.3%、29.3%和39.1%。Cox回归分析显示, 具有冠心病家族史的ST患者MACE发生率增加3.36倍;双支血管ST的患者MACE发生率增加5.15倍。结论:经过长期随访发现, ST患者预后较差, MACE发生率逐年升高。冠心病家族史和双支血管ST是MACE的独立预测因素。
- 支架 /
- 冠状动脉血栓 /
- 危险因素 /
- 冠心病家族史
Abstract: Objective: To evaluate the incidence and predictors of major adverse cardiac events (MACE) in patients with angiographically confirmed stent thrombosis (ST).Method: Consecutive patients with angiographically confirmed stent thrombosis in our center were enrolled from January 2005 to September 2012.Demographic data, medical history (diabetes mellitus, hypertension, myocardial infarction), family history of coronary artery disease, smoking, left ventricular ejection factor, laboratory test results, the type of ST (early, late and very late), treatments of intervention (aspiration thrombectomy, intra-aortic balloon pump, glycoproteinⅡb/Ⅲa inhibitor, additional stent implantation and TIMI flow grade) and medical therapy (antiplatelet agents, statins and angiotension converting enzyme inhibitor) administered to patients in hospital and during follow-up were collected.Death and MACE (including cardiac death, recurrent definite ST, non-fatal MI, and any ischemia-driven target-vessel revascularization) in hospital and during follow-up were recorded.Cox regression analysis was performed to assess the predictors for MACE.Result: Fifty four patients with angiographically confirmed stent thrombosis were reported in our center.Among them, 5 patients died from cardiac-related causes in hospital.The average follow-up time for the remaining 49 patients was 48.1±25.1 months (16 to 107 months) until December 2013.The cumulative incidence of MACE in-hospital was 14.8%.And the incidences at 1, 2, 3, 4and 5years were 16.7%, 20.7%, 25.3%, 29.3% and 39.1%, respectively.On univariate analysis, family history of coronary artery disease, simultaneous two-vessel ST, HDL-C and multivessel disease were the potential predictors of MACE (all P＜0.10).After using Cox regression analysis, family history of coronary artery disease (odds ratio:3.36) and two-vessel ST (odds ratio:5.15) were independent predictors of MACE in this cohort.Conclusion: Patients who sufferedfrom ST were considered to have a poor prognosis after long-term follow up.The cumulative incidence of MACE increased year by year.In addition, family history of coronary artery disease and simultaneous two-vessel ST were independent predictors of MACE.
- stents /
- coronary thrombosis /
- risk factors /
- family history of coronary artery disease

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