糖尿病伴发急性心肌梗死患者直接经皮冠状动脉腔内成形术后近期与远期预后

The early and late clinical outcomes of diabetic patients complicated with acute myocardial infarction treated by primary percutaneous transluminal coronary angioplasty

目的 探讨糖尿病伴发急性心肌梗死 (AMI)患者直接经皮冠状动脉腔内成形术 (PTCA)后近期与远期预后。方法 339例连续行直接PTCA的AMI患者分成糖尿病组 (6 3例 )与非糖尿病组(2 76例 ) ,分析两组患者一般临床特征及冠状动脉病变特点 ,并随访主要心血管事件的发生率。结果 两组间冠状动脉病变差异无显著性 ;糖尿病组与非糖尿病组比较 ,近期随访中 (1个月内 )左室射血分数 (LVEF)减低 (0 .5 4± 0 .10 ) %vs (0 .6 0± 0 .13) % ,P <0 .0 5 ,非致命性心力衰竭发生率增高 (16 .7%vs 7.1% ,P <0 .0 5 ) ,但心脏性病死率差异无显著性 (P >0 .0 5 ) ;远期随访平均 (2 0 .6± 8.7)个月 ,糖尿病组非致命性心力衰竭与靶血管血运重建率增高 (P分别为 <0 .0 5 ,P <0 .0 1) ,主要心血管事件发生率增加 (6 3.0 %vs 32 .7% ,P <0 .0 1) ,且无主要心血管事件存活率降低 (37 0 %vs 6 7 3% ,P <0 0 1) ,但两组间总心脏性病死率 ,差异无显著性 (7.4%vs 3.9% ,P >0 .0 5 ) ;多变量分析显示 ,糖尿病因素及LVEF值与主要心血管事件发生率密切相关 ,是影响无主要心血管事件存活率的独立危险因素 ,但糖尿病是无主要心血管事件存活率降低的最重要的预测因素 (RR4.15 ,95 %可信区间 :l.2 9～ 15 .6 2 )。结论 AMI伴糖尿病患者?

Objective To evaluate the early and late clinical outcomes of diabetic patients complicated with acute myocardial infarction (AMI) treated by primary percutaneous transluminal coronary angioplasty(P PTCA). Methods Three hundred and thirty nine patients with AMI consecutively treated by PTCA were divided into diabetes group(63 cases )and non diabetes group (276 cases).The baseline clinical characteristics, coronary angiogram and major cardiovascular events(MACE) were analysed. Results No significant differences were observed in coronary artery lesions between the two groups. During early follow up period (within 1 month), the left ventricular ejection fraction(LVEF) was lower(0.54±0.10 vs 0.60±0.13, P <0.05), and the incidence of non fatal heart failure was higher (16.7% vs 7.1%, P <0.05) in diabetes group than in non diabetes group, but cardiac death rate was similar in the two groups( P >0.05). At late follow up period (mean 20.6±8.7 months), the incidence of non fatal heart failure and rate of target vessel revascularization increased ( P <0.05, P <0.01, respectively), the incidence of MACE also increased (63.0% vs 32.7%, P <0.01) and survival rate freedom from MACE decreased (37.0% vs 67.3%, P <0.01) in diabetes group, compared with those in non diabetes group, but total cardiac mortality rates were similar in the two groups (7.4% vs 3.9%, P >0.05). Multivariate analysis indicated that diabetes and the value of LVEF were associated with incidence of MACE and each was respectively independent risk factor affecting survival rate freedom from MACE, diabetes was the stronger predictor for the decreased survival rate from MACE ( RR 4.15, 95% CI :1.29 15.62). Conclusions Survival rate freedom from MACE was lower in AMI patients with than without diabetes treated by P PTCA, but overall cardiac mortality rates were similar in the two groups, which suggest that P PTCA in diabetes maybe more likely to reduce the clinical mortality rate as compared with previous reports about thrombolytic therapy.