即使在現今這個盛行藥物支架的時代裡，藥物支架內再阻塞仍然是一個常見的重要問題。目前主要的治療方針仍然存在許多爭論和不確定性。我們的研究就是針對藥物支架內再阻塞的病人，比較進行心導管的兩種治療方式：藥物氣球以及藥物支架的臨床預後。2011年1月到2015年12月間，從4898位支架內再阻塞的病患中，找出540位藥物支架內再阻塞的病患，依據治療策略，分成兩組：藥物氣球338位，藥物支架202位。主要心血管風險定義為死亡，心肌梗塞，腦中風，以及病灶血管再灌流。兩組的病患屬性分布和血管攝影嚴重度均無顯著差異。主要心血管事件發生率為13.51%，其中藥物氣球組為12.13%，而藥物支架組為15.84%，P值為0.283，所以兩組五年的心血管風險發生率是相當類似的。以迴歸分析發現，早期六個月內的再阻塞，冠狀動脈繞道手術病史，使用第一代藥物的藥物支架再阻塞為主要心血管風險發生的危險因子。所以結論是藥物氣球和藥物支架的長期臨床治療效果是一樣好的，而早期六個月內的再阻塞、冠狀動脈繞道手術病史、使用第一代藥物的藥物支架再阻塞三項為心血管風險的重要預測因子。

In-stent restenosis (ISR) is still a common problem even in the drug-eluting stent (DES) era. The optimal treatment strategy is still controversial. This study aimed to evaluate the long-term clinical outcomes after the treatment of DES in-stent restenosis (DES-ISR) on the basis of the initial strategy of using a drug-eluting balloon (DEB) or repeated DES implantation. From Jan 2011 to Dec 2015 , 4898 consecutive patients underwent percutaneous coronary intervention with DES in our hospital. Of the patients,540 with DES-ISR treated with either DEB (n = 338) or DES (n = 202) constituted the study population. Major adverse cardiovascular and cerebrovascular events (MACCE), including death, non-fatal myocardial infarction, non-fatal stroke, and target lesion revascularization (TLR) were analyzed. Differences in baseline and angiographic characteristics were not significant between the groups. The total incidence of MACCE was 13.51% (DEB vs DES group: 12.13% vs. 15.84%; P = 0.283). The 5-year incidence rates of MACCE were similar between the groups. Multivariable Cox regression analysis revealed that shorter time interval to DES-ISR,CABG, and initial first-generation DES-ISR were independent risk factors of MACCE. Long-term outcomes were comparable between the DEB and DES groups. Shorter time interval to first DES-ISR, CABG, initial first generation DES-ISR were important predictors of future MACCE and TLR after reintervention for DES-ISR.

致 謝 ----------------------------------------------------------i
中文摘要 ----------------------------------------------------------ii
英文摘要 ----------------------------------------------------------iii
目 錄 ----------------------------------------------------------iv
圖 目 錄 ----------------------------------------------------------vi
表 目 錄 ----------------------------------------------------------vii
第一章 緒 論 ------------------------------------------------------01
第一節 研究背景與動機 -------------------------------------------01
第二節 研究目的 -------------------------------------------------03
第二章 文獻探討 ---------------------------------------------------04
第一節 藥物支架內再阻塞的定義與成因------------------------------04
第二節 藥物支架內再阻塞的處理方式--------------------------------05
第三章 研究方法 ---------------------------------------------------09
第一節 研究架構 -------------------------------------------------09
第二節 研究假設--------------------------------------------------10
第三節 研究對象 -------------------------------------------------10
第四節 研究工具與分析 -------------------------------------------11
第四章 研究結果 ---------------------------------------------------13
第一節 病患的基本屬性和病灶嚴重度 -------------------------------13
第二節 病患的存活曲線 -------------------------------------------14
第三節 病患的預後因子--------------------------------------------18
第五章 研究結果討論分析--------------------------------------------21
第一節 病患基本資料分析 -----------------------------------------21
第二節 病患存活曲線分析 -----------------------------------------21
第三節病患的預後因子分析 ----------------------------------------22
第六章 結論與建議 -------------------------------------------------25
第一節 研究結論 -------------------------------------------------25
第二節 研究建議 -------------------------------------------------25
第三節 研究限制 -------------------------------------------------26
第四節 未來研究建議 ---------------------------------------------26
第五節 研究貢獻--------------------------------------------------27
參考文獻-----------------------------------------------------------28

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