药物洗脱支架置入与冠状动脉搭桥治疗糖尿病患者冠状动脉多支病变近中期疗效的比较

Comparation drug eluting stents and coronary artery bypass graft in diabetes patients with multivessel coronary artery disease

目的:比较雷帕霉素洗脱支架(DES)置入术与冠状动脉搭桥术(CABG)治疗糖尿病并发冠状动脉多支病变患者的近中期疗效。方法:回顾性分析2003-07-01-2004-06-30入院并接受DES置入或CABG治疗的糖尿病患者490例的基础临床资料、院内及院外随访资料,比较不同冠状动脉血运重建方式对糖尿病多支病变患者临床结果的影响。结果:250例患者接受DES置入(DES组),240例患者选择CABG治疗(CABG组)。与DES组相比,CABG组患者的冠状动脉病变更为复杂,左主干病变以及慢性闭塞病变的比例较高;DES组弥漫长病变以及再狭窄病变的比例较高。CABG组与DES组院内不良心脑血管事件(MACCE)发生率差异无统计学意义(3.3%∶1.2%,P>0.05)。共有440例患者接受了不同形式的随访,随访率为89.7%。2组患者随访病死率、非致死性脑卒中以及非致死性心肌梗死的发生率均差异无统计学意义;但DES组患者需要再次血运重建的比例明显高于CABG组(11.3%∶1.9%,P<0.01);DES组患者随访MACCE发生率高于CABG组(17.4%∶8.6%,P<0.01)。再次血运重建比例较高是导致DES组随访不良事件增加的主要原因。结论:糖尿病多支病变患者CABG后近中期MACCE发生率低于DES置入术。

Objective：To compare the clinical outcomes of contemporary revascularization technique in diabetes with multivessel coronary artery disease（MVD） and evaluate the effectiveness of drug eluting stent in ＂real world＂ clinical practice. Method： A total of 490 diabetes patients with MVD revascularied with PCI or CABG from July 1, 2003 to June 30, 2004 were recruited. All patient＇s clinical manifestations, inhospital revascularization characteristics and follow up results were analyzed retrospectively. Resuit：PCI was performed and DES was implanted in 250 patients （DES group）. CABG were performed in 240 patients （CABG group）. Compared with DES group, coronary lesions characteristic in CABG group were more complex, the proportion of left main disease and chronic total occlusion were higher than that of in DES group. The proportion of diffuse long lesions and instent restenosis in DES group were higher than that in CABG group. The main adverse cardio-cerebral events （all casused death, non-fatal myocardial infarction, non-fatal stroke and repeat revascularization） inhospital were similar between two group （3.3% vs 1.2% ,P〉0.05）, 440 patients completed clinical follow up, during the period of follow up, there were not statistical difference in mortality and non-fatal myocardial infarction between two groups, The rate of main adverse cardio-cerebral events in DES group was a higher than that of in CABG group（17.4% vs 8.6% ,P〈0.01）. mainly because of an increased repeat revascularization in DES group （11.3% vs 1.9%, P〈0.01）. Conclusion： The rate of main adverse cardio-cerebral events in patients with MVD was lower in CABG group even in the era of drug eluting stents.