急诊介入治疗老年糖尿病急性心肌梗死患者的近期疗效

In-hospital effect of primary percutaneous coronary intervention on aged patients with acute myocardial infarction and diabetes mellitus

目的评价急诊经皮冠状动脉介入治疗(PCI)对老年糖尿病急性心肌梗死(AMI)患者住院期间的疗效.方法将1995年12月至2005年4月收治的556例老年(≥60岁)AMI患者分为糖尿病组(DM组,127例)和非糖尿病组(ND组,429例),于发病24 h内行急诊PCI,比较两组患者的临床和冠状动脉造影特征、PCI成功率及术后并发症发生率.结果 DM组患者前壁AMI、非ST段抬高型AMI、Killip Ⅲ～Ⅳ级、IABP置入百分比均显著高于ND组( P <0.05);DM组患者59.1 %的梗塞相关血管为前降支,显著高于 ND组(45.0 %, P <0.05);DM组三支病变率为77.2 %,显著高于ND组(60.8 %, P <0.01).PCI即刻成功率、术中无复流发生率、住院期间PCI术后并发症发生率和病死率两组比较差异均无统计学意义.结论急诊PCI治疗老年糖尿病AMI患者可获得良好的近期疗效.

Objective To evaluate the in-hospital effect of emergency percutaneous coronary intervention （PCI） on aged patients with acute myocardial infarction （AMI） and diabetes mellitus.Methods The clinical data of 556 patients aged ≥160 with AMI hospitalized from December 1995 to April 2005, who underwent emergency PCI within 24 hours after the onset, including 127 cases complicated with diabetes mellitus （Group DM） and 429 cases without diabetes （non-diabetes mellitus group, Group ND ）,were analyzed respectively. Results There were not significant differences in age, sex, smoking rate,hypertension rate, myocardial infarction （MI） rate, and time between onset and treatment between these 2 groups. However, the percentages of anterior wall AMI rate, non-ST elevation myocardial infarction, Killip Ⅲ-Ⅳ grade, and intra-aortic balloon pump （IABP） application of Group DM were 58.3%, 13.4%,27.6%, and 16. 5%, all significantly higher than those of Group ND （46. 4%, 6. 8%, 27.6%, and 8.6%, P 〈0. 001, 0. 02, 0. 03, and 0. 01 ）. In Group DM, 59. 1% of the infarction related artery was left anterior descending branch, and in Group ND 45.0% of the infarction related artery was left anterior descending branch （P 〈 0. 05 ）. The rate of triple vessel disease in Group DM was 77. 2 %, significantly higher than that of the Group ND （ 60. 8 %, P 〈 0. 01 ）. There were no significant differences in the PCI immediate success rate, intra-operational no-reflow rate, post-PCI complication rate and mortality during hospitalization between the two groups. Conclusion Emergency in-hospital PCI is effective on aged AMI patients with diabetes mellitus.