糖尿病患者冠状动脉内支架术后的远期疗效

Long-term outcomes after elective coronary stenting in diabetic patients

目的 探讨糖尿病患者选择性冠状动脉 (冠脉 )内支架术的远期疗效。方法 80 8例冠心病患者行选择性冠脉内支架术 ,其中糖尿病组 174例 ,非糖尿病组 6 34例。随访两组患者远期结果。结果 两组支架术成功率 (96 0 %和 96 1% )相似。平均随访 (19± 7 8)个月 (6～ 4 2个月 ) ,临床随访率为 95 3%。随访期内 ,与非糖尿病组相比 ,糖尿病组心功能改善者 (5 2 2 %比 6 1 0 % )较少 ,再住院率 (4 2 7%比 32 5 % )增加 ;且心脏事件 (30 6 %比 2 2 2 % )、再狭窄 (19 1%比 12 5 % )及总死亡(10 2 %比 4 6 % )均显著增加。多因素分析显示 ,糖尿病为死亡 (OR =2 2 0 ,95 %CI 1 12～ 4 33,P =0 0 2 2 )和再狭窄 (OR =1 6 6 ,95 %CI 1 0 4～ 2 6 7,P =0 0 35 )的独立预测因素。结论 糖尿病患者选择性冠脉内支架术远期结果可以接受 ,但糖尿病仍是远期不良预后的独立预测因素。

Objective To observe the long-term outcomes following coronary stenting in diabetic patients with coronary artery disease. Methods This cohort study comprised 808 consecutive patients with coronary artery disease who underwent elective coronary stenting,including 174 diabetic patients and 634 non-diabetic patients. The long-term follow-up outcomes were compared. Results Procedural success rate was similar (96.0% vs 96.1%). Follow-up rate was 95.3%. Mean follow-up duration was (19±7.8) months(ranged from 6 to 42 months). Compared with non-diabetic patients,diabetic patients had less improvement of cardiac function (52.2% vs 61.0%),more re-admission (42.7% vs 32.5%),and higher occurrence rates of major adverse cardiac events (30.6% vs 22.2%),angiographic restenosis rate (19.1% vs 12.5%) and mortality (10.2% vs 4.6%). Logistic regression analysis indicated that diabetes mellitus was an independent predicator of death (odd ratio 2.20,95%CI 1.12～4.33,P=0.022) and restenosis (odd ratio 1.66, 95%CI 1.04～2.67,P=0.035). Conclusion Diabetic patients undergoing elective coronary stenting have acceptable long-term outcomes,but diabetes mellitus is still independently associated with worse late prognosis.