糖尿病合并冠状动脉慢性完全闭塞性病变患者置入药物洗脱支架的远期预后

Long-term clinical outcome of patients with diabetes and chronic total occlusion underwent drug- eluting stents implantation

目的 评价糖尿病合并冠状动脉慢性完全闭塞性（CTO）病变患者置入药物洗脱支架（DES）的远期临床预后。方法回顾性分析143例于2006年1月至2007年5月期间连续入院接受经皮冠状动脉介入治疗并置人DES的糖尿病合并CTO病变患者的临床资料，并对患者进行随访。研究终点为主要不良心血管事件，包括死亡、心肌梗死和再次靶病变血管重建。根据随访结果，将患者分为事件组和非事件组。结果143例患者中，139例完成随访，4例失访，随访（19．8±5．1）个月。长期随访中共发生主要不良心血管事件15例（10．5％），其中死亡3例，心肌梗死1例，再次靶病变血管重建11例。与非事件组比较，事件组的残余狭窄较重[（17．7±1．8）％比（15．4±5．0）％，P=0．001]，最终最小管腔直径较小[（2．14±0．22）％比（2．89±0．37）％，P=0．004]。Cox回归分析显示，最终最小管腔直径（OR：0．097，95％可信区间：0．013—0．694，P=0．020）为长期随访预后惟一独立危险因素。结论糖尿病合并CTO患者置入DES安全、有效。最终最小管腔直径可能为长期随访事件的莺要预测因子。

Objective The aim of this study was to assess the long-term clinical outcome of patients with diabetes mellitus and chronic total occlusion （CTO） underwent drug-eluting stents （DES） implantation. Methods Data of 143 consecutive eligible patients from January, 2006 to May, 2007 were retrospectively analyzed. The endpoint of the study was the major adverse cardiac events （MACE）, including death, myocardial infarction, target lesion revascularization. The patients were divided into two groups, event group and non-event group, according to the result of follow-up. Results Long-term follow-up was finished in 139 （97. 2% ） patients. Mean follow-up duration was （ 19. 8 ± 5. 1 ） months. MACE rate was 10. 5% during follow-up： 3 deaths, 1 myocardial infarction and 11 repeated target lesion revascularization with PCI. Compared with the non-event group, the percentage of residual lesion [ （ 17.7 ±1.8 ） % vs. （ 15.4 ± 5.0）% ,P = 0. 001 ] was significantly higher in the event group, however, the final minimal luminal diameter [ （2. 14±0. 22）% vs. （2. 89±0. 37）% ,P =0. 004] was lower. Cox regression analysis showed that final luminal diameter （ OR： 0. 097, 95% CI： 0. 013-0. 694, P = 0. 020） was the only dependant predictor at follow-up. Conclusion Final minimal luminal diameter is an independent predictor of MACE during follow-up for patients with diabetes and CTO underwent DES implantation.