| Objective The purpose of this study is to analyze the clinical factors,stent-related factors characteristics of coronary artery lesions and treatment options that may be related to the formation of coronary artery aneurysms after DES implantation,and to provide a basis for preventing or reducing the occurrence of coronary aneurysms and selecting the best treatment strategy for patients who have already occurred,and to reduce the incidence of adverse cardiac events caused by coronay artery aneurysms.Methods In the study,1267 patients(1862 lesions)were enrolled in the Affiliated Hospital of Zunyi Medical College from January 2008 to January 2017 who were diagnosed with coronary heart disease by coronary angiography and successfully implanted DES,finished follow-up coronary angiography after PCI.According to the result of coronary angiography,those patients were divided into CAA group and non-CAA group.The CAA group are 14 patients(14 lesions)and the non-CAA group are 1253 patients(1848 lesions).The two groups of patients' history data,serum lipid level,LVEF,coronary artery lesion,intraoperative operation and stent were analyzed retrospectively.Two class logistic regression was used to analyze the relationship between the differential indicators and the CAA after DES implantation.In addition,analysing the CAA group patients' clinical characteristics,treatment stategy and prognosis,and then summarized clinical features,optimal treatment strategy and long term prognosis of coronary artery aneurysms formation after drug-eluting stent implantation.Results(1)The incidence of CAA was 1.1% in the enrolled patients.(2)Lesion length,serial stent,bifurcation lesion,chronic total occlusion,postoperative minimal lumen diameter,and in-stent restenosis are different between the CAA group and the non-CAA group.It was statistically significant(P<0.05).(3)Two class logistic regression showed that chronic total occlusion,lesion length,and postoperative minimal lumen diameter were possibly independent risk factors for coronary artery aneurysms formation after DES implantation in patients with coronary heart disease.(4)In 14 patients with coronary heart disease who developed CAA after DES implantation,The morphology of the aneurysms showed ectatic in 7 cases(7/14,50%),saccular in 6 cases(single saccular in 3,multiple saccular in 3 cases)(6/14,42.8%),fusiform in 1 case(1/14,7.1%).3 patients(3/14,21.4%)developed coronary artery aneurysms within 1 year after stent implantation,while another 11 patients(11/14,78.6%)found coronary artery aneurysms in 1 year later.4patients(4/14,28.6%)had chest tightness and chest pain when they found coronary artery aneurysms,and 1 patien(1/14,7.1%)presented with shortness of breath.The remaining 9patients(9/14,64.3%)had no symptoms.In the lesion site,there were 1 case(1/14,7.1%)with LM,9 cases(9/14,64.3%)with LAD,0 case with LCX,and 4 cases(4/14,28.6%)with RCA.In terms of treatment,only 1 patient(1/14,7.1%)in all CAA patients had a tumor diameter of 15 mm,which was treated membrane stent implantation.The tumor diameter of the another 13 patients(13/14,92.9%)were all below 10 mm,and given aspirin and clopidogrel combined with anti-platelet aggregation therapy.In the later follow-up,3patients(3/14,21.4%)developed non-ST-segment elevation myocardial infarction(NSTEMI),and they discontinued clopidogrel after CAA formation during the follow-up period,and the time from discontinuation to the myocardial infarction was 6months,7months and18 months.All the other patients were regularly given double-antiplatelet therapy,and no MACE events occurred during the follow-up.Conclusion(1)Chronic total occlusion,lesion length,and postoperative minimal lumen diameter are possibly independent risk factors for the formation of coronary artery aneurysms after DES implantation in patients with coronary heart disease.(2)Most of CAA patients with coronary heart disease after DES implantation possibly showed a benign process under the treatment of double anti-platelet therapy. |
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