药物洗脱支架治疗2型糖尿病合并冠心病多支血管病变的中期疗效

Mid-term result of implantation of drug eluted stent for diabetic patients with multivessel coronary artery lesions

目的对比分析裸金属支架(BMS)与药物洗脱支架(DES)在2型糖尿病(T2DM)合并多支冠脉病变经皮冠状动脉介入治疗(PCI)应用中的安全性和中期疗效,为DES治疗此类患者提供依据。方法连续入选2002年11月～2005年6月首次接受PCI治疗的443例T2DM合并多支冠脉血管病变患者,其中BMS组226例,雷帕霉素(Cypher)支架组91例,紫杉醇(TAXUS)支架组126例,分析患者住院期间及随访6个月的临床情况。结果三组患者临床特征、手术成功率及住院期间主要不良心脏事件(MACE)发生率等指标均无明显差异。Cypher支架组中病变长度和分叉病变的比例及TAXUS支架组中3支血管和分叉病变的比例均明显高于BMS组(P<0.05或0.01)。两DES组的造影随访再狭窄率明显低于BMS组(Cypher组3.2%、TAXUS组4.5%vsBMS组37.3%,P<0.05),临床随访6个月MACE发生率亦明显低于BMS组(Cypher组5.7%、TAXUS组5.8%vsBMS组18.5%,P<0.01)。结论与BMS相比,T2DM合并多支冠脉血管病变患者植入Cypher支架和TAXUS支架安全性高,6个月中期疗效较理想。

Objective To evaluate the 6-month result of implantation of drug eluted stent （DES） in diabetic mellitus （DM） patients with multivessel coronary artery disease （MVD） to compare with that of bare metal stent （BMS）. Methods From November 2002 to June 2005, 443 consecutive T2DM patients with MVD without previous myocardial revascularization underwent successful percutancous coronary intervention （PCI）. There were 226 patients in BMS group, 91patients in Cypher stent group, and 126 patients in TAXUS stent group. The results during hospitalization and 6-month clinical follow-up were analyzed among the 3 groups. Results There were no difference in clinical characteristics, PCI success rate, and incidence of in-hospital major adverse cardiac events （MACE） among 3 groups. However, concerning the characteristics of coronary lesions, the rate of bifurcation lesions and lesion length in Cypher stent group and the rates of bifurcation lesions and triple coronary lesions in TAXUS stent group were significantly higher than that in BMS group, respectively （P〈 0. 05 or〈0. 01）. Anglographic restenosis occurred less in DES groups than in BMS group （3. 2% in Cypher group and 4. 5%in TAXUS group vs 37. 3% in BMS group, P〈0. 05）. Meanwhile, the incidence of MACE at 6-month follow-up period differed significantly between two DES groups and BMS group （5. 7% in Cypher group and 5.8% in TAXUS group vs 18. 5% in BMS group, P〈0. 01）. Conclusion As compared with BMS implantation, DES implantation is a safe and efficient PCI procedure with favorable influences on the 6-month proqnosis in T2DM patients with MVD.