【摘要】 目的 分析在真实临床环境下复杂冠状动脉病变植入雷帕霉素洗脱支架后发生再狭窄的影响及预测因素。方法 选择2002年9月～2004年5月所有住院接受雷帕霉素洗脱支架(SES)的冠心病患者，建议所有患者术后6～9个月复查冠脉造影；记录患者临床特征、PCI手术及复查造影相关参数，采用相多元逻辑回归分析等方法评价上述各参数与再狭窄的关系。结果 (1)258例患者中，有173例(67.1%)患者于术后6～9个月接受了造影随访，平均随访时间为(215±54)天；(2)造影再狭窄率为10.1%，其中8.1%位于支架内(in-stent)，1.1%位于支架近端边缘处，0.9%位于支架远端边缘处；(3)多元逻辑回归分析结果显示下列参数是植入SES再狭窄发生的独立预测因素：分叉病变(OR 2.91，95%CI 1.17～7.05；P<0.01)；开口病变(OR 2.72，95%CI 1.08～6.37；P=0.03)；支架内再狭窄病变(OR 2.29，95%CI 1.12～5.61；P=0.02)；合并糖尿病(OR 2.16，95%CI 1.97～5.28；P<0.01)以及小血管病变(OR 1.56，95%CI 1.12～1.79；P<0.01)；(4)在合并上述再狭窄发生高危因素患者中实际再狭窄发生率依次为分叉病变19.6%、开口病变15.9%、支架内再狭窄病变16.25%、合并糖尿病13.4%、直径≤2.5mm 11.7%。结论 真实临床环境下，SES植入后平均7个月造影随访再狭窄的发生率比较低(10.1%)，主要与支架植入前冠脉病变特点及合并糖尿病有关。

    【关键词】 真实临床环境；雷帕霉素洗脱支架；再狭窄；影响因素

    Clinical,angiographic,and procedural predictors of angiographic restenosis after sirolimus-eluting stent implantation in complex coronary lesions in the “real world”

    SONG Xian-tao,CHEN Yun-dai,LV Shu-zheng,et al.Department of Cardiology,Capital University of Medical Sciences Affiliated Beijing Anzhen Hospital,Beijing 100029,China

    【Abstract】 Objective To analyze the factors associated with occurrence of restenosis after sirolimus-eluting stent(SES)implantation in complex patients.Methods A cohort of consecutive complex patients treated with SES implantation was selected from Sep,2002 to May,2004.All patients were recommended receiving procedure of angiography 6 to 9 months later,and clinical,angiographic and procedural characteristics were read-in.Results (1)In 258 cases,67% received angiographic follow-up,and the average time was 215±54 days.(2)Angiographic restenosis rate was 10.1%,and 8.1% were located in-stent segment,1.1% were at proximal edge of stent and 0.9% were at distal edge of stent.(3)The following characteristics were identified as independent multivariate predictors: bifurcation lesions(OR 2.91,95%CI 1.17～7.05;P<0.01)；ostial location(OR 2.72, 95%CI 1.08～6.37;P=0.03)；ISR(OR 2.29,95% CI 1.12～5.61;P=0.02)；diabetes(OR 2.16, 95%CI 1.97～5.28;P<0.01)and vessel diameter ≤2.5mm(OR 1.56,95%CI 1.12～1.79;P<0.01).(4)The actual restenosis rate in bifurcation lesions,ostial location,ISR,diabetes and small vessels was 19.6%,15.9%,16.25,13.4% and 11.7% respectively.Conclusion Angiographic restenosis after SES implantation in complex patients is an infrequent event in the “real world”,occurring mainly in association with lesion-based characteristics and diabetes mellitus. ......