Bare metal stent restenosis is not a benign clinical entity
Bare metal stent restenosis is not a benign clinical entity
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DOI：
10.1016/j.ahj.2005.08.011
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发表时间：
2006-06-01
影响因子：
4.8
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Chen, Michael S.;John, Jim M.;Bhatt, Deepak L.
背景经皮冠状动脉介入治疗（PCI）后的再狭窄被认为以稳定的方式表现为劳累性心绞痛。然而，支架内再狭窄（ISR）的表现还没有得到很好的研究。我们假设大部分裸金属ISR表现为急性冠状动脉综合征。我们的目的是表征的严重程度的临床表现ISR.Methods我们搜索我们的PCI数据库的所有情况下，PCI裸金属ISR发生在1999年5月至2003年9月。排除了多支血管介入。支架内再狭窄表现分为三类：（1）心肌梗死（MI），（2）血管造影术前需要住院的不稳定型心绞痛，（3）劳力型心绞痛。初始支架置入后的常规血管造影筛查没有进行，所以ISR事件的临床，而不是血管造影，ISR.Results我们确定了1186例裸金属ISR的984例患者。中位年龄为63岁，72%为男性，36%患有糖尿病。ISR事件，9.5%的急性心肌梗死（7.3%的非ST段抬高心肌梗死和2.2%的ST段抬高心肌梗死），26.4%的不稳定型心绞痛需要住院前血管造影，和64.1%的劳力性angina.Conclusions超过三分之一的裸金属ISR事件提出心肌梗死或不稳定型心绞痛需要住院治疗。裸金属ISR的临床表现的严重性似乎比以前认为的更严重。积极的努力，如药物洗脱支架，以减少裸金属ISR引起的不稳定型心绞痛的发生率，是必要的。
Background Restenosis after percutaneous coronary intervention (PCI) has been thought to present in a stable manner as exertional angina. However, the presentation of in-stent restenosis (ISR) is not well-studied. We hypothesized that a substantial proportion of bare metal ISR presents as acute coronary syndromes. We aimed to characterize the severity of the clinical presentation of ISR.Methods We searched our PCI database for all cases of PCI for bare metal ISR occurring between May 1999 and September 2003. Multivessel interventions were excluded. In-stent restenosis presentation was classified into three categories: (1) myocardial infarction (MI), (2) unstable angina requiring hospitalization before angiography, and (3) exertional angina. Routine angiographic screening after initial stent placement was not performed, so ISR episodes were clinical, rather than angiographic, ISR.Results We identified 1186 cases of bare metal ISR in 984 patients. Median age was 63, 72% were male, and 36% had diabetes. Of the ISR episodes, 9.5% presented as acute MI (7.3% as non-ST-segment elevation MI and 2.2% as ST-segment elevation MI), 26.4% as unstable angina requiring hospitalization before angiography, and 64.1% as exertional angina.Conclusions More than one third of bare metal ISR episodes presented as MI or unstable angina requiring hospitalization. The acuity of the clinical presentation of bare metal ISR appears to be more severe than has been previously thought. Aggressive efforts, such as drug-eluting stents to decrease the incidence of unstable angina due to bare metal ISR, are warranted.