Value of DSCT in evaluating in stent restenosis after drug-eluting stent in elderly patients with STEMI
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摘要:
目的探讨双源CT（DSCT）评估老年急性ST段抬高型心肌梗死（STEMI）药物洗脱支架治疗后支架内再狭窄的价值。 方法选取2017年5月~2020年5月在我院治疗的老年STEMI药物洗脱支架治疗术后复诊患者210例，分析DSCT诊断支架内再狭窄的价值，比较支架内再狭窄和通畅患者临床资料差异，采用Logistic回归分析影响因素。 结果经冠状动脉血管造影检查确诊发生支架内再狭窄患者32例，支架内再狭窄发生率为15.24%；DSCT诊断支架内狭窄的敏感度、特异性、准确性、阳性预测值和阴性预测值分别为91.07%、95.00%、94.20%、82.26%和97.66%；DSCT判断直径≥3.0 mm支架内情况准确率高于直径 < 3.0 mm直径（P < 0.05）；支架内再狭窄患者年龄、糖尿病比例、吸烟史比例、LDL-C、支架数量和Gensini评分高于支架内通畅患者（P < 0.05）；Logistic回归分析结果显示：年龄、糖尿病、吸烟史和Gensini评分是老年STEMI药物洗脱支架治疗后支架内再狭窄的危险因素（OR=1.409、1.754、1.842和2.512，P < 0.05）。 结论DSCT评估老年STEMI药物洗脱支架治疗后支架内再狭窄有较高的应用价值，支架内再狭窄受患者年龄、糖尿病及吸烟史、Gensini评分的影响。 Abstract:ObjectiveTo investigate the value of dual source CT (DSCT) in the evaluation of in stent restenosis in elderly patients with acute ST segment elevation myocardial infarction (STEMI) after drug-eluting stent treatment and its influencing factors. MethodsA total of 210 elderly patients with STEMI drug-eluting stents who were treated in our hospital from May 2017 to May 2020 were selected. The value of DSCT in the diagnosis of in-stent restenosis were analyzed, the clinical data of patients with in stent restenosis and patency were compared. The Logistic regression was used to analyze the influencing factors. ResultsThirty-two patients were diagnosed with in-stent restenosis by CAG examination, and the incidence of in-stent restenosis was 15.24%. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of DSCT in the diagnosis of stent stenosis were 91.07%, 95.00%, 94.20%, 82.26% and 97.66%, respectively. The accuracy rate of DSCT in determining the conditions in stents with diameter ≥3.0 mm was significantly higher than that with diameter < 3.0 mm (P < 0.05). The age, proportion of diabetes mellitus, proportion of smoking history, LDL-C, number of stents and Gensini score of patients with stent restenosis were ignificantly higher than those with stent patency (P < 0.05). Logistic regression analysis showed that age, diabetes mellitus, smoking history and Gensini score were risk factors for in-stent restenosis after STEMI drug-eluting stents in the elderly (OR=1.409, 1.754, 1.842 and 2.512, P < 0.05). ConclusionDSCT is of high application value in the assessment of in-stent restenosis after STEMI drug-eluting stent treatment in the elderly, which is influenced by the patient's age, diabetes mellitus, smoking history, and Gensini score. -
表 1 DSCT与CAG诊断支架内再狭窄比较
Table 1. Comparison of DSCT and CAG in diagnosis of in stent restenosis (n)
DSCT CAG 支架内狭窄 通畅 支架内狭窄 51 11 通畅 5 209 
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表 2 DSCT对不同直径内情况诊断准确率比较
Table 2. Comparison of diagnostic accuracy of DSCT in different diameters
直径 支架数 DSCT诊断准确率(%) χ2 P < 3.0 mm 118 104(88.14) 13.895 < 0.01 ≥3.0 mm 158 156(98.73)
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表 3 支架内再狭窄和通畅患者临床资料比较
Table 3. Comparison of clinical data of patients with in stent restenosis and patency[Mean±SD, n(%)]
临床资料 支架内再狭窄(n=32) 支架内通畅(n=178) t/χ2 P 性别 0.611 0.43 男 20(62.50) 98(55.06) 女 12(37.50) 80(44.94) 年龄(岁) 65.43±7.80 58.98±8.12 4.16 < 0.01 BMI(kg/m2) 24.03±2.16 23.96±2.21 0.16 0.86 糖尿病 15(45.88) 32(17.98) 13.03 < 0.01 高血压 22(68.75) 112(62.92) 0.39 0.52 吸烟史 17(53.13) 45(25.28) 10.10 < 0.01 Scr(μmol/L) 71.16±9.98 68.89±10.41 1.14 0.25 eGFR(mL· min-1· 1.73 m-2) 104.41±31.15 106.66±29.87 -0.39 0.69 HbA1c(%) 6.46±0.98 6.52±1.01 -0.31 0.75 ApoA1(g/L) 1.14±0.32 1.16±0.30 -0.34 0.73 LDL-C(mmol/L) 2.10±0.36 1.61±0.32 7.82 < 0.01 HDL-C(mmol/L) 1.06±0.27 1.09±0.23 -0.66 0.50 LVEF(%) 63.98±3.22 64.50±2.97 -0.90 0.36 支架数量(枚/人) 1.96±0.23 1.20±0.18 21.02 < 0.01 Gensini评分(分) 50.56±9.98 34.42±8.89 9.27 < 0.01
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表 4 多因素分析结果
Table 4. Results of multivariate analysis
因素 β SE Walds P OR(95%CI) 年龄 0.343 0.112 9.379 0.000 1.409(1.131~1.755) 糖尿病 0.562 0.192 8.568 0.000 1.754(1.204~2.556) 吸烟史 0.611 0.143 18.256 0.000 1.842(1.392~2.438) Gensini评分 0.921 0.232 15.760 0.000 2.512(1.594~3.958) LDL-C 0.282 0.221 1.628 0.192 1.326(0.860~2.045) 支架数量 0.198 0.132 2.250 0.132 1.219(0.941~1.579) 常数项 0.884 0.336 6.922 0.000 -
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