老年糖尿病合并非ST段抬高的急性冠状动脉综合征的急诊介入疗效观察

Therapeutic effectiveness and safety of the emergency intervent ional therapy in aged diabetic patients with non-ST elevation acute coronar y syndrome

目的 观察≥ 6 0岁老年糖尿病 (DM)合并非ST段抬高的急性冠状动脉综合征 (ACS)患者急诊介入治疗的安全性及临床效果。方法 选择同期行急诊介入治疗的≥ 6 0岁DM合并非ST段抬高的ACS患者 6 3例 (DM组 )与≥ 6 0岁非DM合并非ST段抬高ACS患者 77例 (对照组 ) ,确诊后 2h内行冠状动脉造影证实病变 ,术中仅对“罪犯”病变介入干预。残余狭窄≤ 2 0 % ,前向血流TIMI 3级为手术成功标准 ;心绞痛复发、急性心肌梗死、心源性死亡和靶病变再次血运重建为随访终点。结果 DM组PTCA +支架植入 71枚 ,对照组PTCA +支架植入 71枚 ,直接植入支架8枚 ,手术成功率 (93.7%对 97.4 % ,P >0 .0 5 ) ;患者症状明显减轻或消失率 (88.9%对 94 .8% ,P >0 .0 5 ) ;无急性闭塞和死亡病例。相同方式随访DM组 4 7例及对照组 5 9例 2～ 14个月 ,平均 (8.6± 3.5 )个月 ,心绞痛复发率 (48.9%对32 .2 % ,P >0 .0 5 ) ;无致死性AMI及心脏性猝死发生 ;对DM组 2 9例、对照组 33例冠状动脉造影复查 ,“罪犯”病变的再狭窄率 (31.0 %对 2 1.2 % ,P >0 .0 5 ) ;DM组再狭窄者 6例接受冠状动脉旁路移植术 (CABG) ,1例再次支架植入 ,2例继续接受药物治疗 ,1例因心功能恶化于介入治疗后 3个月死亡 ;非DM组 2例接受CABG ,4例再次PTCA ,其中

Objective To observe the therap eu tic effectiveness and safety of emergency interventional therapy in aged patient s with non-ST elevation acute coronary syndrome(ACS). Methods S ixty-three patients( DM group) aged ≥60 with diabetes mellitus (DM) accompanie d by non-ST elevation ACS and undergoing emergency interventional procedure w ere compared with 77 patients(control group) aged ≥60 with ACS without DM and u ndergoing interventional procedure. Only their “culprit” lesions were interfer ed by emergency interventional procedure. The success criteria of the procedure were the residual stenosis ≤20% and thrombolysis in myocardial infarction (TIMI ) being grade 3. Recurrence of angina, acute myocardial infarction(AMI), cardiac death and target lesion revascularization were the primary endpoints. R esults Sixty-three patients with DM received implantation of 71 stents a fter percutaneous coronary angioplasty(PTCA).Of them, 59 got TIMI grade 3 and 4 patients got grade 2. The average residual stenosis was (9.6±5.7)%. Patients of the control group received implantation of 71 stents after PTCA and 8 stents we re implanted directly. The success rates (93.7% vs 97.4%,P>0.05) were not different significantly between the two groups.The immediate relief of angina of th e patients (88.9% vs 94.8%,P>0.05) was not different significantly too. The re were no acute occlusion and death during the procedures. Forty-seven (DM gro up) and 59 patients (the control group) accepted the follow-up for 2 to 14 (me an 8.6±3.5)months. There were no fatal AMI and cardiac sudden death. Twenty-n ine (DM group)and 33 (the control group) patients received angiography again, Th e rates of recurrent angina(48.9% vs 32.2%,P>0.05) and restenosis(31.0% vs 21.2%,P>0.05) were not different significantly. Six restenosis patients(DM group) accepted CABG,1 case accepted stent again. One patient died of deterior ati on of the heart function after 3 months and 2 patients accepted continued medica l therapy. In the control group, 2 restenosis patients accepted CABG,4 patient s accepted PTCA,3 of them received implantion of stents again, 1 patient accepte d continued medical therapy. Conclusions There were no significa nt differences in procedure success rate, clinical effectiveness and the follow -up results between the two groups. The emergency interventional procedures don e by experienced doctors for aged patients with DM who suffered from non-ST ele vation ACS were effective and safe. It is an optional strategy for the patients with DM accompanied by non-ST elevation ACS.