中华医学杂志（英文版）2009，Vol.122Issue(14)：1610-1614,5.DOI:10.3760/cma.j.issn.0366-6999.2009.14.002
ST-elevated acute myocardial infarction happening 1 month post stent implantation: late thrombosis in-stents or new lesions?
ST-elevated acute myocardial infarction happening 1 month post stent implantation: late thrombosis in-stents or new lesions?
SONG Guang-yuan 1YANG Yue-jin 1XU Bo 2LI Jian-jun 1GAO Run-lin 1QIAO Shu-bin 1YUAN Jin-qing 1TANG Yi-da 1YOU Shi-jie 1PEI Han-jun 1ZHAO Zhen-yan 1WANG Xi-mei 1WU Yong-jian1
作者信息
- 1. Center of Coronary Heart Disease Cardiovascular Institute & Fuwai Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100037,China
- 2. Center of Intervenfional Therapy Cardiovascular Institute & Fuwai Hospital,Peking Union Medical College and Chinese Academy of Medical Sciences,Beijing 100037,China
- 折叠
摘要
Abstract
Background ST-elevated acute myocardial infarction (STEAMI) happening in the first month post percutaneous coronary intervention (PCI) is almost related to acute thrombosis or subacute thrombosis in-stents. This study aimed to investigate the possible causes of myocardial infarction one month later. Methods Patients who had a history of successful PCI, and received coronary angiography or re-PCI due to STEAMI were included in this study. The AMI-related lesions and previous angiographic findings such as the number of lesions, the degree of the stenosis, the type of stents and acute results of last PCI were recorded. If the AMI-related lesion was localized in-stents or at the edge of stents (distance apart from the edge <5 mm), it was defined to be late thrombosis; otherwise as a new-lesion induced AMI. Results One hundred and ninety-two patients aged 40-79 years were included in this study. New lesions, as the cause of STEAMI, were found in 144 patients (Group A, 75%), and late thrombosis in 48 patients (Group B, 25%). Almost all newly built thromboses were found at the sites of previous insignificant lesions (diameter stenosis <50%). There was a significant difference in the average time from previous PCI to AMI ((30.1+12.4) vs (20.3+11.9) months) between the two groups. Diabetes mellitus (DM) and drug-eluting stent (DES) utilization were associated with markedly higher morbidity of late thrombosis in adjusted Logistic regression (hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.1-10.9 and 5.3, 95% CI 1.1-26.5). Conclusions STEAMIs happening 1 month after PCI are more likely to develop from previous insignificant lesion rupture than from late thrombosis in-stents. Moreover, DM and DES are associated with the high incidence of latethrombosis, which may indicate that intensive antiplatelet therapy should be considered in patients with diabetes.关键词
percutaneous coronary intervention/acute myocardial infarction/late thrombosis/diabetes mellitusKey words
percutaneous coronary intervention/acute myocardial infarction/late thrombosis/diabetes mellitus分类
医药卫生引用本文复制引用
SONG Guang-yuan,YANG Yue-jin,XU Bo,LI Jian-jun,GAO Run-lin,QIAO Shu-bin,YUAN Jin-qing,TANG Yi-da,YOU Shi-jie,PEI Han-jun,ZHAO Zhen-yan,WANG Xi-mei,WU Yong-jian..ST-elevated acute myocardial infarction happening 1 month post stent implantation: late thrombosis in-stents or new lesions?[J].中华医学杂志（英文版）,2009,122(14):1610-1614,5.
