冠心病伴2型糖尿病患者PCI预后分析

Outcomes in Patients with Type 2 Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

目的分析糖尿病(DM)与非糖尿病(NDM)患者成功接受经皮冠状动脉介入治疗(PCI)的预后情况以及2型糖尿病与冠心病预后的相关性。方法将1356例成功接受PCI的冠心病患者依据是否合并2型糖尿病分为DM组292例和NDM组1064例,记录并比较性别、年龄、高血压史、冠心病家族史等一般情况,纤维蛋白原(FIB)、血脂、尿酸等实验室指标及心脏超声指标,依据冠脉造影(CAG)结果的SYNTAX评分将患者分为低分、中分及高分组。比较DM组和NDN组PCI术后12个月内全因死亡、心肌梗死(MI)、靶血管再血管化(TVR)和卒中等主要不良心脑血管事件(MACCE)发生情况。结果 DM组患者FIB、尿酸水平高于NDM组,左心室射血分数低于NDM组,差异均有统计学意义(P<0.01)。DM组SYNTAX积分高于NDM组,在SYNTAX积分低分组、中分组及高分组,糖尿病患者所占比例逐渐升高,差异有统计学意义(P<0.01)。随访期间DM组较NDM组MI、死亡及总MACCE比例均较高,差异均有统计学意义(P<0.01)。DM组与NDM组TVR及卒中比例差异均无统计学意义(P>0.05)。结论冠心病合并2型糖尿病患者PCI术后发生MACCE比例高,在冠心病患者的二级预防中应加强对其血糖、血脂的控制。

Objective To compare outcomes in diabetic and non-diabetic patients with coronary artery disease （CAD） undergoing successful percutaneous coronary intervention （PCI） , and the relationship between type 2 diabetes mellitus （T2DM） and outcomes of CAD. Methods A total of 1 356 patients undergoing successful PCI were divided into diabetic group （DM, n=292） and non-diabetic group （NDM, n=l 064）. The clinical data of gender,age,history of hypertension and history of coronary heart disease were recorded. Levels of fibrinogen, blood lipids and uric acid, and echocardiography parameters were also recorded. Using the SYNTAX score to evaluate the outcomes of CAD, then all the patients were divided into three groups including high, medium and low score group. The endpoints were main adverse cardiovascular and cerebrovascular events （MACCE）, including all-cause death, myocardial infarction （MI）, target vessel revascularization （TVR） and stroke in 12 months. Results Compared with NDM group, levels of FIB and uric acid were higher in DM group, while the mean left ventricular ejection fraction （LVEF） was significantly lower in DM group （P 〈 0.01）. The mean SYNTAX score was higher in DM group than that in NDM （P 〈 0.01）. The proportions of DM were gradually increased in the lower, medium and higher SYNTAX score group （P 〈 0.01）. During the follow-up the proportions of MI, death and total MACCE were significantly higher in DM group than those of NDM group （all P 〈 0.01）. There was no significant difference in the proportion of TVR between DM and NDM groups （P 〉 0.05）. Conclusion The CAD patients with T2DM have a higher proportion of MACCE. For patients with CAD, their blood sugar and blood lipids should be controlled in the secondary prevention of coronary heart disease.