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Acta medica Medianae
2013, vol. 52, br. 4, str. 5-11
jezik rada: engleski
vrsta rada: izvorni naučni članak

Kliničke i angiografske karakteristike bolesnika sa trombozom stenta
aClinic of Cardiovascular Diseases, Clinical Center, Niš
bFaculty of Medicine, Niš + Clinic of Cardiovascular Diseases, Clinical Center, Niš
cFaculty of Medical Sciences, Kragujevac + Clinic of Cardiology, Clinical Center of Kragujevac
dUniverzitet u Kragujevcu, Medicinski fakultet

e-adresa: miodragd@ptt.rs

Sažetak

Tromboza stenta (TS) je posle perkutane koronarne intervencije (PCI) retka, ali potencijalno fatalna komplikacija, sa učestalošću od 1% do preko 5%. Faktori rizika za TS mogu da se podele na faktore koji su u vezi sa samim bolesnikom, sa procedurom, tipom stenta i karakteristikama lezije. U studiju je uključeno 1055 bolesnika kojima je urađena PCI tokom 2009. i 2010. godine i koji su praćeni naredne dve godine. Bolesnici sa sigurnom TS čine ispitivanu (TS+), a bolesnici bez sigurne TS kontrolnu grupu (TS-). Sigurna TS definisana je prema kriterijumima ARC (Academic Research Consortium). Sigurnu TS imalo je 23 bolesnika (2,2%). Rana TS zabeležena je kod 73,9%, kasna kod 8,7%, a vrlo kasna kod 17,4% bolesnika. Akutni infarkt miokarda sa ST elevacijom (STEMI) bio je najčešća klinička prezentacija (56,6% vs 20%, p<0,005) u ispitivanoj grupi. Prekid uzimanja aspirina i/ili clopidogrela (34,7%), kao i rezistencija na ove lekove (34,7%), NYHA klasa ≥2 (39,1% vs 17,1%, p<0,02) i manja ejekciona frakcija leve komore (42,3 vs 49,8, p<0,001) bili su glavni faktori TS koji se tiču samih bolesnika. Veći procenat stenoze lezija (92% vs 86%, p<0,05), veća prosečna dužina stenta (19,69 vs 17,01mm, p<0,05), mali dijametar stenta ('potcenjena lezija') (21,7% vs 4,3%, < 0,01), manji pritisak insuflacije stenta (14,84 vs 16,02atm, p<0,05) i disekcija koronarne arterije (26,1% vs 8,6%, p<0,005) bili su signifikantni razlozi za nastanak TS. Kod bolesnika obe grupe primenjen je sličan tip stenta: BMS ('bare metal stents) (69,6% vs 72,9%, NS) i DES ('drug eluting stents') (30,4% vs 27,1%, NS). Bolesnici sa STEMI, kao i oni sa oslabljenom sistolnom funkcijom leve komore, pod najvećim su rizikom za nastanak TS, u više od 2/3 slučajeva u prvih 30 dana nakon PCI (rana TS). Prekid uzimanja aspirina i/ili clopidogrela ili rezistencija na ove lekove dovode do TS (rana TS). Veći procenat stenoze lezija, veća dužina stenta, mali dijametar stenta ('potcenjena lezija'), manji pritisak insuflacije i disekcija koronarne arterije su najčešći proceduralni razlozi za nastanak TS. Tip stenta (BMS i DES) nije značajno uticao na pojavu TS.

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Reference

Cheneau, E., Leborgne, L., Mintz, G.S., Kotani, J., Pichard, A.D., Satler, L.F., Canos, D., Castagna, M., Weissman, N.J., Waksman, R. (2003) Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation, 108(1): 43-7
Cutlip, D.E., Windecker, S., Mehran, R., Boam, A., Cohen, D.J., van Es, G., Steg, G.P., Morel, M., Mauri, L., Vranckx, P., McFadden, E., Lansky, A., Hamon, M., Krucoff, M.W. (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation, 115(17): 2344-51
D`Ascenzo, F., Bollati, M., Clementi, F., Castagno, D., Lagerqvist, B., de la Hernandez, J.T., ten Berg, J.M., Brodie, B.R., Urban, P., Jensen, L.O., Sardi, G., Waksman, R., Lasala, J.M. (2013) Incidence and predictors of coronary stent thrombosis: Evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. International Journal of Cardiology, 167(2): 575-584
de la Torre-Hernández, J.M., Alfonso, F., Hernández, F., Elizaga, J., Sanmartin, M., Pinar, E., Lozano, I., Vazquez, J.M., Botas, J., de Perez, P.A., Hernández, J.M., Sanchis, J., Nodar, J.R.M. (2008) Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpañol sobre TROmbosis de stents FArmacoactivos). Journal of the American College of Cardiology, 51(10): 986-90
Doyle, B., Rihal, C.S., O'Sullivan, C.J., Lennon, R.J., Wiste, H.J., Bell, M., Bresnahan, J., Holmes, D.R. (2007) Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents. Circulation, 116(21): 2391-8
Gori, A.M., Marcucci, R., Migliorini, A., Valenti, R., Moschi, G., Paniccia, R., Buonamici, P., Gensini, G.F., Vergara, R., Abbate, R., Antoniucci, D. (2008) Incidence and clinical impact of dual nonresponsiveness to aspirin and clopidogrel in patients with drug-eluting stents. Journal of the American College of Cardiology, 52(9): 734-9
Heestermans, A.A.C.M., van Werkum, J.W., Zwart, B., van der Heyden, J.A., Kelder, J.C., Breet, N.J., van't Hof, A.W.J., Dambrink, J.E., Koolen, J.J., Brueren, B.R.G., Zijlstra, F., ten Berg, J.M. (2010) Acute and subacute stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: incidence, predictors and clinical outcome. Journal of thrombosis and haemostasis, 8(11): 2385-93
Holmes, D.R., Kereiakes, D.J., Garg, S., Serruys, P.W., Dehmer, G.J., Ellis, S.G., i dr. (2010) Stent thrombosis. J Am Coll Cardiol, 56 (17): 1357-1365
Iqbal, J., Sumaya, W., Tatman, V., Parviz, Y., Morton, A.C., Grech, E.D., Campbell, S., Storey, R.F., Gunn, J. (2013) Incidence and predictors of stent thrombosis: a single-centre study of 5,833 consecutive patients undergoing coronary artery stenting. EuroIntervention, 9(1): 62-9
Kastrati, A., Mehilli, J., Pache, J., Kaiser, C., Valgimigli, M., Kelbaek, H., Menichelli, M., Sabaté, M., Suttorp, M.J., Baumgart, D., Seyfarth, M., Pfisterer, M.E., Schömig, A. (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. New England journal of medicine, 356(10): 1030-9
Lev, E.I., Patel, R.T., Maresh, K.J., Guthikonda, S., Granada, J., DeLao, T., Bray, P.F., Kleiman, N.S. (2006) Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance. Journal of the American College of Cardiology, 47(1): 27-33
Mauri, L., Hsieh, W., Massaro, J.M., Ho, K.K.L., D'Agostino, R., Cutlip, D.E. (2007) Stent thrombosis in randomized clinical trials of drug-eluting stents. New England journal of medicine, 356(10): 1020-9
Muller, I., Besta, F., Schulz, C., Massberg, S., Schonig, A., Gawaz, M. (2003) Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for electice coronary stent placement. Throm Haemost, 89: 783-787
Orford, J.L., Lennon, R., Melby, S., Fasseas, P., Bell, M.R., Rihal, C.S., Holmes, D.R., Berger, P.B. (2002) Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry. Journal of the American College of Cardiology, 40(9): 1567-72
Pfisterer, M., Brunner-La, R.H.P., Buser, P.T., Rickenbacher, P., Hunziker, P., Mueller, C., Jeger, R., Bader, F., Osswald, S., Kaiser, C. (2006) Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. Journal of the American College of Cardiology, 48(12): 2584-91
Räber, L., Magro, M., Stefanini, G.G., Kalesan, B., van Domburg, R.T., Onuma, Y., Wenaweser, P., Daemen, J., Meier, B., Jüni, P., Serruys, P.W., Windecker, S. (2012) Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents: a prospective cohort study. Circulation, 125(9): 1110-21
Roukoz, H., Bavry, A.A., Sarkees, M.L., Mood, G.R., Kumbhani, D.J., Rabbat, M.G., Bhatt, D.L. (2009) Comprehensive meta-analysis on drug-eluting stents versus bare-metal stents during extended follow-up. American journal of medicine, 122(6): 581.e1-10
Shaw, E.S., Singh, V., Martinezclark, P., O’Neill, W.W. (2010) Very Late (10-Year-Old) Bare Metal Stent Thrombosis. Cardiology, 115(2): 127-129
Spaulding, C., Daemen, J., Boersma, E., Cutlip, D.E., Serruys, P.W. (2007) A Pooled Analysis of Data Comparing Sirolimus-Eluting Stents with Bare-Metal Stents. New England Journal of Medicine, 356(10): 989-997
Spaulding, C., Teiger, E., Commeau, P., Varenne, O., Bramucci, E., Slama, M., Beatt, K., Tirouvanziam, A., Polonski, L., Stella, P.R., Clugston, R., Fajadet, J., de Boisgelin, X., Bode, C., Carrié, D. (2011) Four-Year Follow-Up of TYPHOON (Trial to Assess the Use of the CYPHer Sirolimus-Eluting Coronary Stent in Acute Myocardial Infarction Treated With BallOON Angioplasty). JACC: Cardiovascular Interventions, 4(1): 14-23
Thayssen, P., Jensen, L.O., Lassen, J.F., Tilsted, H.H., Kaltoft, A., Christiansen, E.H., Hansen, K.N., Ravkilde, J., Maeng, M., Krusell, L., Madsen, M., Sørensen, H.T., Thuesen, L. (2012) The risk and prognostic impact of definite stent thrombosis or in-stent restenosis after coronary stent implantation. EuroIntervention, 8(5): 591-8
Uren, N.G., Schwarzacher, S.P., Metz, J.A., Lee, D.P., Honda, Y., Yeung, A.C., Fitzgerald, P.J., Yock, P.G. (2002) Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. European heart journal, 23(2): 124-32
van Werkum, J.W., Heestermans, A.A., Zomer, A.C., Kelder, J.C., Suttorp, M.J., Rensing, B.J., i dr. (2009) Predictors of coronary stent thrombosis. The Dutch Stent Thrombosis Registry. J Am Coll Cardiol, 53 (16): 1399-1409
van Werkum, J.W., Heestermans, A.A.C.M., de Korte, F.I., Kelder, J.C., Suttorp, M., Rensing, B.J.W.M., Zwart, B., Brueren, B., Koolen, J.J., Dambrink, J.E., van`t Hof, A.W.J., Verheugt, F.W.A. (2009) Long-term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases. Circulation, 119(6): 828-34
Wijns, W., Kolh, P., Danchin, N., Di, M.C., Falk, V., Folliguet, T., Garg, S., Huber, K., James, S., Knuuti, J., Lopez-Sendon, J., Marco, J., Menicanti, L., Ostojic, M., Piepoli, M.F., Pirlet, C. (2010) Guidelines on myocardial revascularization. European heart journal, 31(20): 2501-55