目的

探讨冠心病合并类风湿关节炎（RA）患者经皮冠脉介入术（PCI）后支架内血栓形成的机制，以及PCI 的适应证及手术时机的选择。

方法

选择2021 年3 月5 日济宁医学院附属医院心内科收治的1 例冠心病合并RA 患者PCI 术后死亡病例的临床资料，并复习相关文献。

结果

患者既往RA 病史30 年，长期服用激素类药物，病情控制欠佳 ，近10 d 疼痛加重，既往冠心病病史10年，曾行PCI。抗环瓜氨酸肽抗体85.33 U/mL，类风湿因子66.6 U/mL，红细胞沉降率42 mm/h，C 反应蛋白17.4 mg/L，D-二聚体0.66 mg/L。2021 年3 月14 日，术前冠状动脉CT 提示冠状动脉狭窄。2021 年3 月16 日冠状动脉造影示：左前降支（LAD）近段狭窄90%，D1 开口狭窄95%。患者行PCI，于LAD 近段植入1 枚支架。术后30 min，患者感心前区剧烈疼痛，急诊冠脉造影示LAD 支架内血栓形成，心肌梗死溶栓试验前向血流0 级。经积极救治后，患者死亡。

结论

合并RA 急性期的冠心病患者PCI 后易形成支架内血栓，术前需充分评估适应证，并选择合适的时机。

Objective

To explore the mechanism of stent thrombosis after percutaneous coronary intervention （PCI） in a patient with coronary heart disease and rheumatoid arthritis （RA），and to explore the indications and timing of PCI.

Methods

The clinical data of a patient with coronary heart disease complicated with RA who died after PCI in the Department of Cardiology of the Affiliated Hospital of Jining Medical University on March 5，2021 were selected，and the relevant literature was reviewed.

Results

The patient had a 30-year history of RA，which was poorly controlled by long-term use of hormone drugs，and the pain worsened in the past 10 days.The patient had a 10-year history of coronary heart disease and underwent PCI.The anti-cyclic citrulline peptide antibody was 85.33 U/mL，rheumatoid factor 66.61 U/mL，erythrocyte sedimentation rate 42 mm/h，C-reactive protein 17.4 mg/L，and D-dimer 0.66 mg/L.On March 14，2021，preoperative coronary angiography showed acute stent thrombosis.On March 16，2021，coronary angiography showed 90% stenosis in the proximal segment of left anterior descending （LAD） and 95% stenosis in the opening of D1 branch.The patient underwent PCI and a stent was implanted in the proximal segment of the LAD.Thirty minutes after the operation，the patient felt severe pain in the precordial area.Emergency coronary angiography showed thrombosis in the LAD stent，and the thrombolysis in myocardial infarction flow grade was 0.After active treatment，the patient died.

Conclusions

Coronary heart disease patients with RA in the acute phase are prone to stent thrombosis after PCI.It is necessary to fully evaluate the indications and choose the appropriate time before PCI.