| ObjectivesThis study aimed to explore the relationship between cardiovascular risk factors andGensini score of coronary long lesions. At the same time, the safty and efficacy ofdrug-eluting stent with different length, different types and different degradationcharacteristics of polymer were compared, and then to understand the efficacy of longdrug-eluting stent implantation.MethodsA total of418cases who wre admitted to CHANGHAI hospital between June2011andJune2012and underwent percutaneous coronary interventionology were selected in this study.They were divided into short stent group(<20mm, n=124),long stent group(21-28mm,29-36mm, overlap stent, n=294). Correlated analysis and multivariate linear regressionanalysis were made between risk faoctors and the Gensini score. Clinical follow-up aboutmajor adverse cardiac events(MACE), including cardic death, nonfetal myocardial infarctionand revascularization of target vessel, was done after PCI12-18months respectively.Results1. Compared with the short stent group, there was significant higher in the incidence ofdiabetes32.31%vs22.58%, apolipoprotein B(Apo B)0.95±0.24mmol/L vs0.84±0.18mmol/L, Apo B/apolipoprotein A1(Apo A1)0.74±0.20vs0.65±0.16, the proportion of heavysmokers56.12%vs33.06%, number of risk fackors4.87±2.01vs4.31±1.93in the longstent group respectively(P<0.05<0.01,<0.01,<0.01,<0.01).2. Among418patients, smoking, the severity of CHD, LDL-C, Apo B, Apo B/Apo A1,Lipoprotein(a), number of risk fackors were positively related with the Gensini score, whileHDL-C was negatively related with it (P<0.05). Then the multivariate linear regressionanalysis showed that the severity of CHD, LDL-C, number of risk fackors were independentlycorrelated with Gensini score positively. HDL-C was independently correlated with Gensiniscore negatively.3. Compared with the short stent group(16.62±1.89mm), there was significant higher inthe perioperative troponin-I positive rate68.97%v44.19%, proportion of advanced ballondilation64.63%vs48.39%, proportion of subsequent ballon dilation40.48%vs20.97%,proportion of non-ST segment elevation myocardial infarction9.52%vs4.03%, Gensini score32.93±21.49vs28.26±19.05, rate of coronary artery branch stenosis15.31%vs8.06%than inthe long stent group(16.62±1.89mm)respectively (P<0.05). Proportion of unstable angina pectoris(UAP)44.56%vs48.39%in the short stent group was significant higher than in thelong stent group (P<0.05). The incidence of cumulative major adverse cardiac events at12-18months of follow-up was not statistically different between the2groups.4. Compared with sirolimus-eluting stent group(n=362), there was significant higher inthe proportion of ST segment elevation myocardial infarction29.28%vs14.29%, proportionof right coronary artery24.31%vs10.71%, the length of stent29.19±13.07mm vs24.41±10.85mm than in everolimus-eluting stent group respectively (n=56, P<0.05). Theproportion of stable angina pectoris(SAP)17.40%vs30.36%, size of stent3.15±0.43mm vs3.28±0.43mm in the sirolimus-eluting stent group was significant less than in theeverolimus-eluting stent group (P<0.05). The incidence of acute complication during PCI andcumulative major adverse cardiac events at12-18months of follow-up was not statisticallydifferent between the2groups.5. Compared with drug-eluting stent with biodegradable polymer group(n=185), therewas significant higher in the size of stent3.25±0.46mm vs3.11±0.41mm than in the durablepolymer group (n=233, P<0.05). The incidence of acute complication during PCI andcumulative major adverse cardiac events at12-18months of follow-up was not statisticallydifferent between the2groups.6. Compared with domestic stent group(n=362), there was significant higher in theproportion of ST segment elevation myocardial infarction29.40%vs12.96%, proportion ofright coronary artery24.18%vs11.11%, the length of stent29.28±12.93mm vs23.31±9.36mm than in the overseas stent group(n=54, P<0.05). The proportion of stableangina pectoris(SAP)17.31%vs31.48%, size of stent3.15±0.43mm vs3.29±0.43mm in thedomestic stent group was significant less than in the overseas stent group (P<0.05). Theincidence of acute complication during PCI and cumulative major adverse cardiac events at12-18months of follow-up was not statistically different between the2groups.Conclusions1. The long drug-eluting stent group in our study with more serious condition andcombined more risk factors, but medium-term DES use in diffuse coronary lesions isassociated with favorable results.2. After sirolimus and everolimus drug-eluting stent implantation, the medium-termfollow-up of its efficacy and safty is similar.3. After drug-eluting stent with biodegradable and durable polymer implantation, themedium-term follow-up of its efficacy and safty is similar. 4. After domestic and overseas stent implantation, the medium-term follow-up of itsefficacy and safty is similar. |
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