背景:目前可用的药物洗脱支架(DES)植入后预防支架血栓形成(ST)的双重抗血小板治疗的最佳持续时间仍存在争议。延迟愈合通常被认为是早期ST的主要原因。然而,目前尚缺乏对DES植入后的支柱覆盖进行彻底的病理学研究-本研究解决了这一差距.
方法:根据我们199个支架病变的尸检登记,组织学评估了来自66个目前可用的DES支架病变的4,713个支柱,植入持续时间≤370天。内皮覆盖定义为存在覆盖支柱和下面的平滑肌细胞层的腔内皮细胞。将支架病变分为急性冠脉综合征(ACS)组(n=40)和慢性冠脉综合征(CCS)组(n=26)并进行比较。通过逻辑分析确定内皮覆盖预测因子。
结果:尽管ACS和CCS病变具有相当的临床特征,包括年龄,性别,和死因,后者的慢性肾脏病和血液透析患病率明显高于前者(33.3%vs.65.2%;p=0.02,7.7%与30.4%;p=0.02)。ACS病变的支架植入后中位持续时间明显短于CCS病变(13[IQR5-26天]vs.40[IQR16-233天];p<0.01)。在目前可用的DES植入后30天时内皮覆盖率为3.5%,90天时为27.7%。多变量逻辑回归分析暗示植入物持续时间≤90天[比值比(OR),0.009;95%置信区间(CI),0.006-0.012;p<0.01],浅表钙化(OR,0.11;95%CI,0.07-0.17;p<0.01),ACS罪犯网站(或,0.29;95%CI,0.09-0.94;p=0.039),和周向耐用的聚合物涂层DES(或,0.32;95%CI,0.24-0.41;p<0.01)作为延迟内皮覆盖预测因子。
结论:目前可用的DES植入后90天,内皮覆盖有限,ACS罪犯部位和周向耐久的聚合物涂层DES被确定为延迟内皮覆盖的独立预测因子。我们的发现表明,植入后潜在的斑块形态和支架技术对血管愈合的重要性。
BACKGROUND: The optimal duration of dual antiplatelet therapy after currently available drug-eluting stent (DES) implantation to prevent stent thrombosis (ST) remains controversial. Delayed healing is frequently identified as a leading cause of ST in the early phase. However, a thorough pathological investigation into strut coverage after currently available DES implantation is lacking-a gap addressed in the current study.
METHODS: From our autopsy registry of 199 stented lesions, 4,713 struts from 66 currently available DES-stented lesions with an implant duration ≤370 days were histologically evaluated. Endothelial coverage was defined as the presence of luminal endothelial cells overlying struts and an underlying smooth muscle cell layer. The stented lesions were classified into acute coronary syndrome (ACS) (n = 40) and chronic coronary syndrome (CCS) (n = 26) groups and were compared. Endothelial coverage predictors were identified through logistic analysis.
RESULTS: Although ACS and CCS lesions presented comparable clinical characteristics, including age, sex, and cause of death, the latter exhibited a significantly higher prevalence of chronic kidney disease and hemodialysis than the former (33.3% vs. 65.2%; P = .02, 7.7% vs. 30.4%; P = .02). The poststent implant median duration was significantly shorter in ACS lesions than in CCS lesions (13 [IQR 5-26 days] vs. 40 [IQR 16-233 days]; P < .01). The endothelial coverage percentage was 3.5% at 30 days and 27.7% at 90 days after currently available DES implantation. Multivariable logistic regression analysis implicated implant duration of ≤90 days (odds ratio [OR], 0.009; 95% confidence interval [CI], 0.006-0.012; P < .01), superficial calcification (OR, 0.11; 95% CI, 0.07-0.17; P < .01), ACS culprit site (OR, 0.29; 95% CI, 0.09-0.94; P = .039), and circumferentially durable polymer-coated DES (OR, 0.32; 95% CI, 0.24-0.41; P < .01) as delayed endothelial coverage predictors.
CONCLUSIONS: Endothelial coverage was limited at 90 days after currently available DES implantation, and the ACS culprit site and circumferentially durable polymer-coated DES were identified as independent predictors of delayed endothelial coverage. Our findings suggest the importance of underlying plaque morphology and stent technology for vessel healing after such implantation.