Local persistent hypercoagulability after sirolimus-eluting stent implantation in patients with stable angina.
Local persistent hypercoagulability after sirolimus-eluting stent implantation in patients with stable angina.
复制标题
稳定型心绞痛患者植入西罗莫司洗脱支架后局部持续高凝状态。
DOI：
10.1016/j.ijcard.2010.08.014
复制
发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Sata M
中科院分区：
文献类型：
--
作者：
Yamaguchi K;Wakatsuki T;Niki T;Kusunose K;Koshiba K;Yagi S;Taketani Y;Iwase T;Tomita N;Yamada H;Soeki T;Akaike M;Sata M
西罗莫司洗脱支架（SES）植入后晚期支架血栓形成（LST）已被证实。虽然不完全的新生内膜覆盖后SES植入已报道，局部长期高凝状态仍然unknow.METHODSWe评估了83个连续的稳定型心绞痛患者的局部持续凝血反应，治疗与SES（n=51）或BMS（n=32）孤立的新发左前降支（LAD）狭窄植入。我们测量了冠状窦（CS）和主动脉窦（V）中的凝血酶原片段F1+2（frF 1 +2）和D-二聚体水平。SES组的Δ frF 1 +2和Δ D-二聚体显著高于BMS组（分别为0.50±0.35 vs −0.14±0.15nmol/l，p=0.009和0.24±0.21 vs −0.05±0.16μg/ml，p=0.041）。我们从SES患者中选择低凝[Δ frF 1 +2<0.15（平均值-SD）nmol/l，n=21]和高凝[Δ frF 1 +2>0.85（平均值+SD）nmol/l，n=14]组。进行多变量分析以确定局部高凝状态的独立预测因素。总SES长度是局部高凝状态的唯一独立预测因子。SES组的Δ frF 1 +2与支架总长度呈显著正相关（r=0.57，p<0.05）。建议对植入较长SES后的患者进行仔细的长期随访，以避免LST。
BACKGROUNDLate stent thrombosis (LST) after sirolimus-eluting stent (SES) implantation has been demonstrated previously. Although incomplete neointimal coverage after SES implantation has been reported, local long-term hypercoagulability remains unknown.METHODSWe evaluated the local persistent coagulative response in eighty-three consecutive patients with stable angina, treated with either SES (n=51) or BMS (n=32) implantation for isolated de novo left anterior descending (LAD) stenosis. We measured prothrombin fragment F1+2 (frF1+2) and D-dimer levels sampled in the coronary sinus (CS) and sinus of Valsalva (V). The transcardiac gradient (Δ) was defined as the CS level minus V level.RESULTSThe ΔfrF1+2 and ΔD-dimer were significantly greater in the SES group than in the BMS group (0.50±0.35 vs −0.14±0.15nmol/l, p=0.009 and 0.24±0.21 vs −0.05±0.16μg/ml, p=0.041, respectively). We selected the hypocoagulative [ΔfrF1+2<0.15 (mean value−SD) nmol/l, n=21] and hypercoagulative [ΔfrF1+2>0.85 (mean value+SD) nmol/l, n=14] groups out of the SES patients. Multivariate analysis was performed to identify independent predictors of local hypercoagulability. Total SES length was the only independent predictor of local hypercoagulability. There was a significant positive correlation between the ΔfrF1+2 and total stent length in the SES group (r=0.57, p<0.05).CONCLUSIONSAn increased local coagulative response was observed in the convalescent phase after SES implantation as compared to BMS. Careful long-term follow-up of patients after longer SES implantation is recommended in order to avoid LST.