coronary artery disease myocardial infarction percutaneous coronary intervention secondary prevention stent thrombosis
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摘要

BACKGROUND:Current data are lacking for incidence, correlates, and prognosis associated with incident myocardial infarction (MI) in patients with stable coronary artery disease (CAD). Furthermore, the contribution of very late stent thrombosis (VLST) to these events remains poorly understood.
OBJECTIVES:This study aimed to analyze the residual risk of MI, together with relevant associated factors, and related mortality in stable CAD outpatients.
METHODS:The multicenter CORONOR (Suivi d'une cohorte de patients COROnariens stables en region NORd-Pas-de-Calais) study enrolled 4,184 unselected outpatients with stable CAD (i.e., MI or coronary revascularization >1 year previously). Five-year follow-up was achieved for 4,094 patients (98%).
RESULTS:We identified a linear risk of incident MI (0.8% annually), with ST-segment elevation MI constituting one-third of all cases. Current smoking, low-density lipoprotein cholesterol, multivessel CAD, diabetes with glycosylated hemoglobin >7%, and persistent angina were all associated with increased risk, and prior bypass surgery was associated with decreased risk. When used as a time-dependent variable, incident MI was associated with an increased risk of death (hazard ratio: 2.05; p < 0.0001). Among patients with prior stent implantation, VLST was causal in 20% of MI cases and presented more often as ST-segment elevation MI versus MI not related to a stented site (59% vs. 26%, p = 0.001). Adjusted mortality was 4 times higher in patients with VLST than in MI not related to a stented site.
CONCLUSIONS:In stable CAD outpatients, incident MI occurs at a stable rate of 0.8% annually, is related to VLST in one-fifth of cases, and is associated with an increased mortality risk, especially for VLST. Multivessel CAD and residual uncontrolled risk factors are strongly associated with MI.

译文

背景: 目前缺乏与稳定性冠状动脉疾病 (CAD) 患者发生心肌梗死 (MI) 相关的发病率、相关性和预后的数据。此外,极晚期支架血栓形成 (VLST) 对这些事件的贡献仍然知之甚少。
目的: 本研究旨在分析稳定的 CAD 门诊患者 MI 的残余风险,以及相关的相关因素和相关的死亡率。
方法: 多中心冠状动脉 (Suivi d 'une cohorte de patient coorte de COROnariens stables en region NORd-Pas-de-Calais) 研究招募了 4,184 名未选择的门诊稳定 CAD 患者 (即, MI 或冠状动脉血运重建> 1 年以前)。4,094 名患者 (98%) 获得了五年随访。
结果: 我们确定了心肌梗死的线性风险 (每年 0.8%),ST 段抬高型心肌梗死占所有病例的 3分之1。目前吸烟、低密度脂蛋白胆固醇、多支血管 CAD 、糖化血红蛋白> 7% 的糖尿病和持续性心绞痛均与风险增加相关,而先前的搭桥手术与风险降低相关。当作为时间因变量使用时,心肌梗死事件与死亡风险增加相关 (危险比: 2.05; p & lt; 0.0001)。在先前支架植入的患者中,20% 的 MI 病例中 VLST 是有因果关系的,并且更常见的表现为 ST 段抬高的 MI 和与支架部位无关的 MI (59% 对 26%, p = 0.001)。VLST 患者的校正死亡率是与支架部位无关的 MI 患者的 4 倍。
结论: 在稳定的 CAD 门诊患者中,每年心梗发生率稳定在 0.8%,5分之1 的病例与 VLST 相关,并且与死亡率增加相关,尤其是 VLST。多血管 CAD 和残余未控制的危险因素与 MI 密切相关。

Stent thrombosis

心血管 ST 疾病
概述  :  

支架内血栓形成(ST)是一种罕见但严重的冠脉手术并发症,其病理生理学较为复杂,死亡率和复发率也较高。ST的个人易感性涉及多因素,它是临床因素、内皮生物学、过敏反应和/或炎症反应、血液流变学、血小板反应性、凝血因子、支架的物理和机械特性,以及上述不同因素对血流动力学影响相互作用的结果。ST的临床预测因子1、患者及病变特征:许多与患者相关、病变相关、设备相关和手术相关的ST预测因子已经被确定,患者和病变的复杂性是ST的重要决定因素。临床因素与ST的相关性取决于支架置入后的时间。例如,糖尿病和肾衰

Stent 英 [stent] 美 [stent]

释义   n. 斯滕特氏印模膏;展伸

adj. 扩张的

例句   Cardiologists have had to decide which type of stent to use in heart attack patients based on small randomized trials that didn't include long-term follow-up and reported conflicting results.

心脏病学家必须在以小没有长期随访并且报告的结果有矛盾的的随机试验的基础上,决定心脏病发作的患者用哪种类型的支架。

 

Thrombosis 英 [θrɒmˈbəʊsɪs] 美 [θrɑːmˈboʊsɪs]

释义   n. [病理] 血栓形成;血栓症

例句   Would you like to share us your experience of fondaparinux or other anticoagulants for the prophylaxis of deep vein thrombosis?

能否与我们一同分享您在使用磺达肝癸钠等抗凝药预防深静脉血栓方面的经验?


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