【摘要】 目的分析急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)术后影响支架血栓(ST)发生的因素。方法选取符合条件接受急诊直接PCI的AMI患者275例,分别植入裸金属支架及国产雷帕霉素洗脱支架。根据有无ST发生分为无ST组(267例)和ST组(8例)。对两组患者的一般临床特征、基础疾病、药物支架比例及平均植入支架数目、多支血管病变及心功能情况、抗血栓药物治疗等方面进行比较,分析AMI患者急诊PCI治疗后ST发生的危险因素。结果 1年的随访期内,发生ST8例(2.9%)。两组间在一般临床特征、基础疾病、药物支架比例及多支血管病变等方面的差异均无统计学意义(P值均>0.05)。与无ST组比较,ST组的糖尿病构成比显著升高(P<0.05),支架长度、左心室舒张末期和收缩末期直径均显著增大(P值均<0.05),植入支架数目显著增多(P<0.05),支架直径、左心室射血分数(LVEF)均显著减小(P值均<0.05)。术后1年随访期内,ST组接受正规双联抗血小板治疗的构成比显著低于无ST组(P<0.05)。以ST发生与否作为因变量,采用多元Logistic回归分析,过早停用双联抗血小板治疗(OR=10.3,95%可信区间为4.10～29.20)和糖尿病(OR=5.2,95%可信区间为1.50～12.80)是AMI患者急诊直接PCI术后发生ST的危险因素(P值均<0.01),而性别、支架种类、梗死相关动脉直径和长度、左心衰竭(LVEF<0.5)等因素与急诊直接PCI术后发生ST不相关(P值均>0.05)。结论糖尿病、是否正规双联抗血小板治疗是AMI患者急诊直接PCI术后1年内ST发生的危险因素。更多还原

【Abstract】 Objective To analyze the risk factor of stent thrombosis in patientswith acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI). Methods A total of 275 AMI patients underwent emergency PCI with bare metal stent ordomestic sirolimus eluting stents. According to the incidence of stent thrombosis (ST), the patients were divided into control group (n=267) and ST group (n=8). The clinical characteristics, underlying diseases, the proportion ofdrug eluting stents, implanted stent amount, multivessel disease and cardiac function, and antithrombotic drug treatment were compared between groups in order to analyze the risk factor of stent thrombosis in patients with AMI after emergency PCI. Results During 1-year follow up, stent thrombosis occurred in 8 cases (2.9%). There were no significant differences in clinical characteristics, underlying diseases, the proportion ofdrug eluting stents, implanted stent amount, or multivesseldisease (all P>0.05). Comparedwith control group, the proportion ofdiabetes mellitus, stent length, and left ventriculardiameter at end-diastole and end-systole were significantly increased, and stentdiameter left ventricular ejection fraction (LVEF)decreased in ST group (all P<0.05). The proportion ofdual antiplatelet therapy in ST groupwas significantly lower than that in control groups (P<0.05). Logistic multiple regression analysis showed that break-off ofdual antiplatelet therapy (OR=10.3, 95%CI:4.10-29.20) and diabetes mellitus (OR=5.2, 95%CI: 1.50-12.80) were the risk factors of stent thrombosis in patients with AMI after emergency PCI (both P<0.01). Gender, stent type, infarct-associated arterial diameter and length, and left heart failure (LVEF<0.5)were not related to stent thrombosis. Conclusion Diabetes and breaking off dual antiplatelet therapy are risk factors for stent thrombosis in patients with AMI after emergency PCI during 1-year follow up. (Shanghai Med J,2013,36:342-345)更多还原