| Purpose:To explore the related factors of in-stent restenosis by observing the in-stent restenosis in patients with acute ST segment elevation myocardial infarction after emergency drug-eluting stent implantation.Method:Through a retrospective study,patients who received drug-eluting stents in emergency PCI of Changhai Hospital from January 01,2014 to December 31,2016 were treated by the same surgical team.All patients came to hospital on time for coronary angiography at 10-14 months after operation,and compared the in-stent vessels in the same position at the time of emergency stent implantation and reexamination.A total of 250 cases were included in the study,which were divided into two groups:restenosis group and non-restenosis group.The observed indicators to be collected included:1.Risk factors of STEMI,including sex,age,history of hypertension,history of type 2 diabetes,history of smoking,etc.2.All the patients studied during emergency surgery,including the location of the lesion,the location of the invaded blood vessel,the occlusion of the blood vessel,the parameters of the stent,whether dilatation after high pressure in the stent,thrombus load,slow blood flow or no reflow during the operation.3.The results of imaging and laboratory examination included the degree of restenosis at the site of stent implantation,triglyceride at the time of onset and reexamination,and low density lipoprotein at the time of onset and reexamination.Result:Subjects were selected from patients who received drug-eluting stents in emergency PCI of Changhai Hospital because of STEMI from January 01,2014 to December 31,2016.among the 250 patients,203(81.2%)were males.There were 47(18.8%)females.The age range was 29 to 91 years old,with an average age of 62.6±11.9 years.According to the occurrence of vascular restenosis,all cases were divided into restenosis group and non-restenosis group.There were 33 patients in restenosis group and 217 patients in non-restenosis group.The statistical results showed that in this study,sex,age,smoking history,history of type 2 diabetes and history of hypertension had no significant effect on the occurrence of restenosis after STEMI treatment(P>0.05).Of the 33 cases in the restenosis group,17 cases underwent post-high pressure dilatation and 16 cases did not.There was no significant correlation between in-stent restenosis and in-stent restenosis(P=0.969).No obvious thrombus load was found in 27 of the 33 patients,accounting for 10.8%of the total sample,and thrombus load occurred in 6 cases,accounting for 2.5%of the total sample.Thrombus load was not statistically correlated with stent restenosis in patients at the time of reexamination(P=0.457).In all samples,there were 222 cases without slow blood flow or no reflow,of which restenosis occurred in 29 cases(13.06%).There were slow blood flow or reflow in 28 cases,of which restenosis occurred in 4 cases(14.28%).There was no significant correlation between slow blood flow or no reflow and in-stent restenosis(P=0.857).According to the location of lesions diagnosed by electrocardiogram,66 patients with anterior wall myocardial infarction accounted for 26.4%of the total samples,8 patients with anterior interwall myocardial infarction accounted for 3.2%of the total samples,and 66 patients with anterior wall myocardial infarction accounted for 26.4%of the total samples.There were 58 patients with inferior myocardial infarction(23.2%)and 114 patients with extensive myocardial infarction(45.6%).There were 1 case of posterior wall myocardial infarction and 3 cases of right ventricular myocardial infarction.The statistical results showed that there was no significant difference in the location of the lesion between the two groups(P=0.087).There were 112 cases of left anterior descending branch(LAD),47 cases of left circumflex branch(LCX),84 cases of right coronary artery(RCA),4 cases of left main artery(LM)and 2 cases of blunt marginal branch(OM).There was no significant difference in the location of vessels invaded between the two groups(P=0.297).In terms of the degree of vascular occlusion,there were 105 cases of complete occlusion(42.0%)and 145 cases of incomplete occlusion(58.0%).There was no significant difference in the degree of vascular occlusion between restenosis group and non-restenosis group(P=0.481).At the time of onset,the LDL-C was 2.53±0.73 mmol in restenosis group and 2.84±0.84 mmol in non-restenosis group.Independent sample test showed that there was significant difference between the two groups(P<0.01).It is suggested that the level of LDL-C is negatively correlated with restenosis at the time of onset.The LDL-C of restenosis group and non-restenosis group were 1.73±0.71 mmol/L and 1.86±0.61 mmol/L respectively Independent sample test showed that there was no significant difference between the two groups(P=0.606).At the time of onset,the TG value was 2.65±3.11 mmol in restenosis group and 1.66±0.83 mmol in non-restenosis group.The independent sample test showed that there was significant difference between the two groups(P<0.01).The TG of restenosis group and non-restenosis group were 1.80±1.55 mmol/L and 1.39±0.78 mmol/L,respectively.the independent sample test showed that there was significant difference between the two groups(P<0.01).It is suggested that the level of TG at the time of onset and reexamination is positively correlated with the occurrence of vascular restenosis at the stent.The results of multivariate analysis suggested that the levels of TG at the time of onset were independent influencing factors for postoperative restenosis.The level of TG at the time of onset was an independent risk factor for restenosis after STEMI.For every 1 unit increase in TG,the probability of restenosis after STEMI increased by 1.498 times within limits.The parameters of stent implantation included stent number,stent length and stent diameter.The statistical results showed that there was no significant difference in stent number,length and diameter between restenosis group and non-restenosis group(P>0.05).The results showed that there was no correlation between postoperative restenosis and stent parameters in patients with STEMI.Conclusion:1.In-stent restenosis after STEMI and whether to dilate after in-stent hypertension,whether there is no reflow or slow blood flow during operation,whether there is thrombus during operation,the location of lesion,the location of invaded blood vessels and the degree of vascular obstruction,and the number of stents,length,diameter and other related parameters were not significantly correlated.2.There was no significant correlation between in-stent restenosis and sex,smoking history,hypertension history and type 2 diabetes.3.The level of triglyceride at the time of onset was an independent risk factor for restenosis after STEMI.For every 1 unit increase in TG,the probability of restenosis after STEMI increased by 1.498 times within limits. |
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