冠心病合并2型糖尿病患者冠状动脉多支病变PCI与CABG术后5年随访

Follow-up for 5 years after percutaneous coronary intervention and coronary artery bypass grafting in patients with coronary multivessel lesions of coronary heart disease complicating type 2 diabetes mellitus

目的：比较冠状动脉粥样硬化性心脏病（冠心病）合并2型糖尿病冠状动脉多支病变患者经皮冠状动脉介入治疗（PCI）置入药物涂层支架（DES）与冠状动脉旁路移植术（CABG）后远期疗效。方法连续入选2002年12月至2008年12月住院期间的冠心病合并2型糖尿病患者，并成功行择期血运重建的多支冠状动脉病变患者，分为CABG组（n=270），DES组（n=285）。随访5年，从术后30 d开始到5年止结束，随访包括全因死亡、心源性死亡、非致死性卒中、非致死性心肌梗死、心绞痛复发和再次血运重建的主要不良心脑血管事件（MACE）。结果入选患者随访率100%。CABG组与DES组两组间5年全因死亡率（1.11%vs.1.40%）、心源性死亡率（0%vs.0%）、非致死性卒中发生率（2.22%vs.2.81%）无统计学差异（P＞0.05）。DES组非致死性心肌梗死发生率（3.15%）、心绞痛复发率（17.89%）、再次血运重建率（12.28%）均高于CABG组（分别为1.11，5.56%，0.74%），差异均有统计学意义（P＜0.05-0.01）。结论多支冠状动脉病变合并2型糖尿病患者CABG与PCI治疗5年生存率无明显差异，但多支冠状动脉病变合并2型糖尿病患者DES支架置入远期心绞痛复发率、再次血运重建率,非致死性心肌梗死发生率高于 CABG组。

Objective To compare the long-term curative effects between implanting drug eluting stent （DES） during percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） in patients with coronary multivessel lesions of coronary heart disease （CHD） complicating type 2 diabetes mellitus （T2DM）. Methods The patients with successful selective revascularization were chosen continuously from Dec. 2002 to Dec. 2008, and divided into CABG group （n=270） and DES group （n=285）. All patients were followed up for 5 years from 30 d after the operation to the 5th year. The content of follow-up included major adverse cardiovascular events （MACE）, such as all-cause mortality, cardiac death, non-fatal stroke, non-fatal myocardial infarction, angina recurrence and onemore revascularization.Results The follow-up rate was 100% in all patients. In 2 groups, 5-year all-cause mortality （1.11%vs. 1.40%）, rate of cardiac death （0% vs. 0%） and incidence of non-fatal stroke （2.22%vs. 2.81%） had no statistical difference （P〉0.05）. In DES group, incidence of non-fatal myocardial infarction （3.15%）, angina recurrent rate （17.89%） and onemore revascularization rate （12.28%） were higher than those in CABG group （1.11, 5.56%, 0.74%, andP〈0.05-P〈0.01）.Conclusion CABG and PCI have no significant difference in 5-year survival rate in patients with coronary multivessel lesions of CHD complicating T2DM, while long-term angina recurrent rate, onemore revascularization rate and incidence of non-fatal myocardial infarction are higher in DES group than those in CABG group.