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

Five years follow up result after application of sirolimus-eluting stent in elderly patients with coronary heart diseaseand combined with diabetes mellitus

目的:探讨老年冠心病合并糖尿病患者经皮冠状动脉介入(PCI)置入雷帕霉素洗脱支架(SES)治疗的远期疗效。方法:回顾性分析老年冠心病合并2型糖尿病(100例)和无糖尿病(100例)患者行PCI的临床及冠脉病变特点、手术成功率和主要不良心脑血管不良事件(MACCE)发生率,并进行两组间比较。结果:两组支架术成功率均为100%。随访率为100%,随访5年,糖尿病组与无糖尿病组术后并发症发生率(8.0%、7.0%)、脑卒中发生率(5.0%、3.0%)差异无统计学意义(P>0.05)。糖尿病组再次血运重建率、非新发心肌梗死率、心绞痛复发率、非心源性死亡率(30.0%、6.0%、42%、10%)均高于无糖尿病组(14.0%、2.0%、20%、2.0%);但两组心源性死亡率均为0。结论:老年冠心病合并糖尿病患者选择性冠脉内置入药物洗脱支架安全,成功率高,远期疗效尚好,但合并糖尿病仍是远期不良预后的独立预测因素。

Objective： To assess the long-term clinical outcomes in patients with coronary artery disease combined with diabetes mellitus after sirolimus-eluting stent（SES） based percutaneous coronary intervention. Method： The lesion characteristics of coronary artery, the success rate of interventional procedures and incidence of major adverse cardiac cerebrovascular events （MACCE） were analyzed retrospectively and compared in elderly patients with coronary heart disease combined with （100 cases） or without （100 cases） type 2 diabetes mellitus. Results： SES were successfully implanted on target lesions in two gruops. Success rate and follow-up were 100%. The five years follow-up results showed there were no significant differences in complication rate（ 8.0% vs 7.0% ） , stroke （5.0%vs 3.0% ） （ all P 〉 0.05 ）. The rate of target vessel revascularization, non- fatal myocardial infarction and angina recurrence rate and mortality（30.0% ,6.0% ,42%, 10% ） were higher in the diabetics group than those in the non-diabetics group（ 14.0% ,2.0% ,20% ,2.0%, P 〈 0.05 ）. Cordially, ardiac death was zero in two groups. Conclusion： Implanting SES in patients with coronary artery disease combined with diabetes mellitus is safe and effective. Long-term outcomes is good,but diabetes mellitus is still independently associated with worse late prognosis.