冠状动脉内长和短及多个支架置入后再狭窄的血管造影随访研究(摘要)
作者：郭静萱 郭丽君 毛节明 张福春 牛 杰 李海燕 陈明哲
单位：北京市，北京医科大学第三临床医学院 心内科(100083)
关键词：
中国循环杂志99zk59 目的：比较单个短和长及多个支架置入的远期血管造影再狭窄率。
方法：回顾性分析1996年5月至1998年10月在我院接受冠状动脉支架置入并有血管造影随访的77例病人的临床及血管造影资料。单个短支架组(A组：支架长度≤20 mm)37例39支血管；单个长支架组(B组：支架长度>20 mm)22例25支血管；多个支架组(C组)18例18支血管置入39个支架。3组在年龄、性别、心肌梗塞史、高血压病史、糖尿病史、高血脂症史、左心室射血分数、病变血管支数及接受支架的适应证的临床和血管造影表现相类似，但3组间的心绞痛病人比例、靶血管分布和病变AHA/ACC分型有明显不同。A、B、C组心绞痛病人分别占53%、80%和83%(P=0.027),靶病变血管A和C组以左前降支(LCD)为多，占64%和83%，而B组靶病变血管以右冠状动脉(RCA)为主，占52%(P=0.002),C型病变在A、B和C组的比例为20.5%、64%和77.8%(P<0.000 1)。
, 百拇医药
结果：3组的平均随访时间平均为7.71±3.63个月、9.78±7.47个月和6.92±2.69个月(P=NS)。3组术前参照血管直径3.15±0.37 mm,3.30±0.42 mm,3.12±0.39 mm、术前最小管腔开放直径(MLD)0.58±0.37 mm,0.42±0.42 mm,0.64±0.52 mm、术后MLD 3.09±0.46 mm,3.03±0.31 mm,2.96±0.30 mm、急性获得2.53±0.65 mm,2.38±0.60 mm,2.31±0.46 mm、支架直径3.21±0.32 mm,3.22±0.25 mm,3.14±0.23 mm、支架血管比值1.05±0.11,1.00±0.12,1.02±0.11、释放支架的最大压力10.56±1.93 atm,10.88±2.33 atm,9.78±2.13 atm(1 atm=101.325 kPa)，在A、B、C组间均无统计学差异。病变长度在B和C组明显长于A组(23.66±12.78 mm和26.42±13.60 mm与10.30±4.67 mm,P<0.000 1);支架长度在B组大于A组，C组大于B组(31.24±7.25 mm与16.49±2.26 mm和41.56±13.54 mm,P<0.000 1和0.002)。随访时MLD和管腔晚期丢失在A和C组间有明显差异(1.91±0.91 mm与1.22±0.87 mm和1.21±0.83 mm与1.74±0.79 mm,P<0.01和0.02),而在A和B组(随访MLD:1.70±0.93 mm、晚期丢失：1.34±0.94 mm)、B和C组间无统计学差异。以随访时支架部位管腔直径狭窄≥50%为再狭窄的判定标准，3组的再狭窄率分别为28.2%、36.0%和61.1%,C组明显高于A组(P<0.05),而B组有高于A组、C组高于B组的趋势，但统计学上无明显差异。Logistic多因素回归分析证实多个支架置入是再狭窄的唯一的独立预测因素(OR=3.29,P<0.05)。
, 百拇医药
结论：多个冠状动脉支架置入是发生晚期血管再狭窄的唯一独立预测因素；而与单个短支架置入相比，单个长支架置入的再狭窄率也有增高的趋势。
Restenosis after Short, Long and Multiple Coronary Stent Implantation: Clinical and Angiographic Follow-up (Abstract)
Department of Cardiology, The Third Hospital, Beijing Medical University, Beijing (100083)
Guo Jingxuan, Guo Lijun, Mao Jieming, et al.
Objective: Coronary artery stenting has been shown to be an effective strategy in the treatment of patients with coronary stenotic lesions. Complex and long lesions may necessitate the use of long or multiple stents. The safety and efficacy of long and multiple coronary stent implantation have not yet been established. This study was undertaken to compare the incidence of restenosis in single short stent implantation and, long and multiple stent implantation.
, http://www.100md.com
Methods: Seventy-seven patients who underwent successful coronary stent implantation between May 1996 and October 1998 were candidates for follow-up coronary angiography. Patients were divided into three groups: The single short stent group (group A, stent length<20 mm) included 37 patients with 39 vessels involved; the single long stent group (group B, stent length>20 mm) included 22 patients with 25 vessels involved; the multiple stent group (group C) included 18 patients with 18 vessels involved. Clinical and angiographic variables were analyzed retrospectively. Baseline characteristics were comparable between the 3 groups, apart from a lower percentage of patients with angina in group A (53%, compared with 80% and 83% in groups B and C, p=0.027), a higher percentage of left anterior descending artery (LAD) involvement in groups A and C (64% and 83% respectively, compared to group B 28.3% (p=0.002) and a higher percentage of AHA/ACC type C lesions in grups B and C (64% and 77% respectively, compared to group A 20.5%, p=0.000 1).
, http://www.100md.com
Results: The mean follow-up periods for the three groups were not significantly different: 7.71±3.63 months for group A, 9.78±7.47 months for group B, and 6.92±2.69 months for group C. The pre-stenting reference vessel diameter (3.15±0.37 mm, 3.30±0.42 mm, 3.12±0.39 mm) and minimal luminal diameter (MLD) (0.58±0.37 mm, 0.42±0.42 mm, 0.64±0.52 mm) and the post-stenting MLD (3.09±0.46 mm, 3.03±0.31 mm, 2.96±0.30 mm, the acute gain (2.53±0.65 mm, 2.38±0.60 mm, 2.31±0.46 mm), the stent diameter (3.21±0.32 mm, 3.22±0.25 mm, 3.14±0.23 mm), the stent/vessel ratio (1.05±0.11, 1.00±0.12, 1.02±0.11) and the maximal balloon inflation pressure (10.56±1.93 atm, 10.88±2.33 atm, 9.78±2.13 atm) wre not significantly different between the three groups. Lesions were longer in groups B and C compared to group A (23.66±12.78 mm and 26.42±13.60 mm vs. 10.30±4.67 mm, p<0.000 1). Stents in group B were longer than in group A (31.24±7.25 mm vs. 16.49±2.26 mm, p<0.000 1); stents in group C were longer compared to group B (41.56±13.54 mm vs. 31.24±7.25 mm, p<0.002). During follow-up, MLD and late loss were significantly differnt between groups A and C (1.91±0.91 mm vs. 1.22±0.87 mm, p<0.01 and 1.21±0.83 mm vs. 1.74±0.79 mm, p<0.02), but not significantly different between groups A and B (MLD 1.70±0.93 mm, late loss 1.34±0.94 mm) and, B and C. Restenosis was defined as a vessel diameter stenosis ≥50% at the stent placement site during follow-up angiography. The restenosis rate was significantly higher in group C compared to group A (61.1% vs. 28.2%, p<0.05). It tended to be higher in group B compared to group A and in group C compared to group B, but was not statistically different. Logistic regression analysis revealed multiple stent implantation to be the only independent predictor of restenosis (OR=3.29, p<0.05).
Conclusion: Multiple stent implantation is the only independent predictor of late restenosis. Compared with short stent implantation, long stent implantation tends to increase the restenosis rate., http://www.100md.com
单位：北京市，北京医科大学第三临床医学院 心内科(100083)
关键词：
中国循环杂志99zk59 目的：比较单个短和长及多个支架置入的远期血管造影再狭窄率。
方法：回顾性分析1996年5月至1998年10月在我院接受冠状动脉支架置入并有血管造影随访的77例病人的临床及血管造影资料。单个短支架组(A组：支架长度≤20 mm)37例39支血管；单个长支架组(B组：支架长度>20 mm)22例25支血管；多个支架组(C组)18例18支血管置入39个支架。3组在年龄、性别、心肌梗塞史、高血压病史、糖尿病史、高血脂症史、左心室射血分数、病变血管支数及接受支架的适应证的临床和血管造影表现相类似，但3组间的心绞痛病人比例、靶血管分布和病变AHA/ACC分型有明显不同。A、B、C组心绞痛病人分别占53%、80%和83%(P=0.027),靶病变血管A和C组以左前降支(LCD)为多，占64%和83%，而B组靶病变血管以右冠状动脉(RCA)为主，占52%(P=0.002),C型病变在A、B和C组的比例为20.5%、64%和77.8%(P<0.000 1)。
, 百拇医药
结果：3组的平均随访时间平均为7.71±3.63个月、9.78±7.47个月和6.92±2.69个月(P=NS)。3组术前参照血管直径3.15±0.37 mm,3.30±0.42 mm,3.12±0.39 mm、术前最小管腔开放直径(MLD)0.58±0.37 mm,0.42±0.42 mm,0.64±0.52 mm、术后MLD 3.09±0.46 mm,3.03±0.31 mm,2.96±0.30 mm、急性获得2.53±0.65 mm,2.38±0.60 mm,2.31±0.46 mm、支架直径3.21±0.32 mm,3.22±0.25 mm,3.14±0.23 mm、支架血管比值1.05±0.11,1.00±0.12,1.02±0.11、释放支架的最大压力10.56±1.93 atm,10.88±2.33 atm,9.78±2.13 atm(1 atm=101.325 kPa)，在A、B、C组间均无统计学差异。病变长度在B和C组明显长于A组(23.66±12.78 mm和26.42±13.60 mm与10.30±4.67 mm,P<0.000 1);支架长度在B组大于A组，C组大于B组(31.24±7.25 mm与16.49±2.26 mm和41.56±13.54 mm,P<0.000 1和0.002)。随访时MLD和管腔晚期丢失在A和C组间有明显差异(1.91±0.91 mm与1.22±0.87 mm和1.21±0.83 mm与1.74±0.79 mm,P<0.01和0.02),而在A和B组(随访MLD:1.70±0.93 mm、晚期丢失：1.34±0.94 mm)、B和C组间无统计学差异。以随访时支架部位管腔直径狭窄≥50%为再狭窄的判定标准，3组的再狭窄率分别为28.2%、36.0%和61.1%,C组明显高于A组(P<0.05),而B组有高于A组、C组高于B组的趋势，但统计学上无明显差异。Logistic多因素回归分析证实多个支架置入是再狭窄的唯一的独立预测因素(OR=3.29,P<0.05)。
, 百拇医药
结论：多个冠状动脉支架置入是发生晚期血管再狭窄的唯一独立预测因素；而与单个短支架置入相比，单个长支架置入的再狭窄率也有增高的趋势。
Restenosis after Short, Long and Multiple Coronary Stent Implantation: Clinical and Angiographic Follow-up (Abstract)
Department of Cardiology, The Third Hospital, Beijing Medical University, Beijing (100083)
Guo Jingxuan, Guo Lijun, Mao Jieming, et al.
Objective: Coronary artery stenting has been shown to be an effective strategy in the treatment of patients with coronary stenotic lesions. Complex and long lesions may necessitate the use of long or multiple stents. The safety and efficacy of long and multiple coronary stent implantation have not yet been established. This study was undertaken to compare the incidence of restenosis in single short stent implantation and, long and multiple stent implantation.
, http://www.100md.com
Methods: Seventy-seven patients who underwent successful coronary stent implantation between May 1996 and October 1998 were candidates for follow-up coronary angiography. Patients were divided into three groups: The single short stent group (group A, stent length<20 mm) included 37 patients with 39 vessels involved; the single long stent group (group B, stent length>20 mm) included 22 patients with 25 vessels involved; the multiple stent group (group C) included 18 patients with 18 vessels involved. Clinical and angiographic variables were analyzed retrospectively. Baseline characteristics were comparable between the 3 groups, apart from a lower percentage of patients with angina in group A (53%, compared with 80% and 83% in groups B and C, p=0.027), a higher percentage of left anterior descending artery (LAD) involvement in groups A and C (64% and 83% respectively, compared to group B 28.3% (p=0.002) and a higher percentage of AHA/ACC type C lesions in grups B and C (64% and 77% respectively, compared to group A 20.5%, p=0.000 1).
, http://www.100md.com
Results: The mean follow-up periods for the three groups were not significantly different: 7.71±3.63 months for group A, 9.78±7.47 months for group B, and 6.92±2.69 months for group C. The pre-stenting reference vessel diameter (3.15±0.37 mm, 3.30±0.42 mm, 3.12±0.39 mm) and minimal luminal diameter (MLD) (0.58±0.37 mm, 0.42±0.42 mm, 0.64±0.52 mm) and the post-stenting MLD (3.09±0.46 mm, 3.03±0.31 mm, 2.96±0.30 mm, the acute gain (2.53±0.65 mm, 2.38±0.60 mm, 2.31±0.46 mm), the stent diameter (3.21±0.32 mm, 3.22±0.25 mm, 3.14±0.23 mm), the stent/vessel ratio (1.05±0.11, 1.00±0.12, 1.02±0.11) and the maximal balloon inflation pressure (10.56±1.93 atm, 10.88±2.33 atm, 9.78±2.13 atm) wre not significantly different between the three groups. Lesions were longer in groups B and C compared to group A (23.66±12.78 mm and 26.42±13.60 mm vs. 10.30±4.67 mm, p<0.000 1). Stents in group B were longer than in group A (31.24±7.25 mm vs. 16.49±2.26 mm, p<0.000 1); stents in group C were longer compared to group B (41.56±13.54 mm vs. 31.24±7.25 mm, p<0.002). During follow-up, MLD and late loss were significantly differnt between groups A and C (1.91±0.91 mm vs. 1.22±0.87 mm, p<0.01 and 1.21±0.83 mm vs. 1.74±0.79 mm, p<0.02), but not significantly different between groups A and B (MLD 1.70±0.93 mm, late loss 1.34±0.94 mm) and, B and C. Restenosis was defined as a vessel diameter stenosis ≥50% at the stent placement site during follow-up angiography. The restenosis rate was significantly higher in group C compared to group A (61.1% vs. 28.2%, p<0.05). It tended to be higher in group B compared to group A and in group C compared to group B, but was not statistically different. Logistic regression analysis revealed multiple stent implantation to be the only independent predictor of restenosis (OR=3.29, p<0.05).
Conclusion: Multiple stent implantation is the only independent predictor of late restenosis. Compared with short stent implantation, long stent implantation tends to increase the restenosis rate., http://www.100md.com