冠心病合并2型糖尿病高龄患者经皮冠状动脉介入治疗的临床观察

Percutaneous coronary intervention for coronary artery disease complicated by type 2 diabetes in octogenarians

目的:有关冠心病合并2型糖尿病患者的冠状动脉介入治疗存在很大争议,高龄患者的治疗未被重视。文章分析冠心病合并2型糖尿病高龄患者(年龄≥80岁)冠状动脉内支架置入术的安全性和远期临床疗效。方法:比较132例冠心病合并糖尿病高龄患者(冠心病合并糖尿病组,其中置入裸支架106例,置入雷帕霉素药物涂层支架26例)与284例不伴糖尿病冠心病高龄患者(冠心病组,其中置入裸支架237例,置入雷帕霉素药物涂层支架47例)冠状动脉内支架置入术的疗效。结果:2组患者的基线资料差异无统计学意义(P>0.05)。冠心病合并糖尿病组与冠心病组比较,冠状动脉病变更复杂、更严重,B2型和C型病变多(63.25%vs40.53%,P<0.05)。2组手术成功率均为100%,近期疗效好,均无严重并发症发生。冠心病合并糖尿病组出现9例穿刺部位血肿(2.33%),冠心病组出现11例穿刺部位血肿(4.87%)。远期随访显示冠心病合并糖尿病高龄患者发生心脑血管不良事件高于不伴糖尿病冠心病高龄患者,但发生率差异无统计学意义(11.5%vs9.7%,P=0.21),再次血运重建率前者明显高于后者(9.1%vs3.9%,P<0.05)。结论:冠心病合并糖尿病高龄患者的冠状动脉病变更复杂、更严重,与不伴有糖尿病的冠心病高龄患者相比,行冠状动脉内支架置入术同样安全有效。

Objective： Controversies exist over the percutaneous coronary intervention for coronary artery disease（CAD） complicated by type 2 diabetes,and the treatment of the disorder has been neglected in the octogenarian cohort.The purpose of this study was to evaluate the safety and the clinical efficacy of coronary stenting in CAD octogenarians with type 2 diabetes.Methods： Totally,284 CAD octogenarians（the CAD group） and 132 CAD octogenarians with type 2 diabetes（the diabetic CAD group） were treated by coronary stenting with bare or rapamycin-coated.And the clinical results were compared between the two groups.Results： No significant differences were found in the baseline data between the two groups（P 〉 0.05）.Coronary artery lesions were obviously more serious and complicated and there were more type B2 and type C lesions in the diabetic CAD group（63.25%） than in the CAD octogenarians（40.53%）（P 〈 0.05）.The success rate of operation was 100% in both the two groups.Conclusion： Stent implantation is safe and effective for coronary artery disease complicated by diabetes in octogenarian patients,and it can reduce major adverse cardiac events.