高龄老年冠心病合并糖尿病患者雷帕霉素洗脱支架置入术后5年随访研究

Follow-up study in elderly patients with coronary heart disease complicating diabetes mellitus after implantation of sirolimus-eluting stent for 5 years

目的探讨糖尿病与非糖尿病高龄老年冠心病冠状动脉置入雷帕霉素洗脱支架（SES）远期疗效的差异。方法纳入2004年1月～2007年12月高龄老年冠心病合并糖尿病患者64例作为糖尿病组，纳入同期不合并糖尿病的高龄老年冠心病患者60例作为对照组，所有患者均行PCI术置入SES支架。随访5年，比较两组的治疗效果和主要心脑血管不良事件（MACCE，包括非心源性死亡、心源性死亡、卒中、心绞痛复发、非致死性心肌梗死和再次血运重建）发生率。结果两组5年随访率均为100%，糖尿病组MACCE发生率（57.8%，37/64）高于对照组（30.0%，18/60），差异有统计学意义（P＜0.05）。与对照组相比，糖尿病组非心源性死亡率及再次血运重建的发生率更高（分别为：7.80% vs.1.67%，15.6% vs.8.33%，P均＜0.05）。两组心源性死亡发生率、心绞痛复发率、非致死性心肌梗死、卒中的发生率均无统计学差异（P＞0.05）。结论高龄老年冠心病患者合并糖尿病不增加PCI术后心源性死亡率，但会增加再次血运重建的发生率。

Objective To investigate the influence of diabetes mellitus （DM） on the long-term curative effect of implanted sirolimus-eluting stent in the elderly patients with coronary heart disease （CHD）. Methods The elderly patients （n=64） with CHD complicating DM were chosen as DM group from Jan. 2004 to Dec. 2007, and at the same time other elderly patients （n=60） with CHD without DM were chosen as non-DM group. All patients were given PCI and SES implantation and followed up for 5 years. The curative effect and incidence of major adverse cardiac and cerebrovascular events （MACCE, including non-cardiac death, cardiac death, stroke, recurrence of angina, nonfatal myocardial infarction and repeated revascularization） were compared between two groups. Results The follow-up rate was 100%in two groups, and the incidence of MACCE was 57.8%（37/64） in DM group and 30.0%（18/60） in non-DM group （P〈0.05）. The incidences of non-cardiac death （7.8%） and repeated revascularization （15.6%） were significantly higher in DM group than those in non-DM group （8.33%vs. 1.67%, all P〈0.05）. There was no statistical difference in the incidences of cardiac death, nonfatal myocardial infarction and stroke and recurrence rate of angina between two groups （P〉0.05）. Conclusion The rate of cardiac death is not be increased but the incidence of repeated revascularization is increased in the elderly patients with CHD complicating DM.