冠心病合并2型糖尿病患者经皮冠状动脉介入术后SYNTAX评分与支架内再狭窄的关联性研究

Evaluation of the SYNTAX score on the coronary in-stent restenosis in patients with diabetes mellitus undergoing percutaneous coronary intervention with drug-eluting stent

目的:探讨冠心病合并2型糖尿病患者经皮冠状动脉介入(PCI)术后,SYNTAX评分与冠状动脉支架内再狭窄(ISR)的关联性。方法:连续入选2012年1月至2012年12月,在我中心行PCI术的冠心病合并2型糖尿病患者共437例,对他们进行2年的随访,其中共有382例完成了第二次冠状动脉造影检查用来以此评价是否发生了ISR,最终共有368例符合该研究的纳入和排除标准进入统计分析。收集患者第一次行冠状动脉支架置入术时的基线信息,SYNTAX评分由在线计算器计算所得。结果:368例患者(男性108例。女性260例)的平均年龄为(58.7±10.3)岁,其中有74例发生了ISR,发生率为20.1%。ISR组的SYNTAX评分为15分,远高于非狭窄组的11分(P=0.022)。多因素回归分析结果显示,在调整了传统危险因素和其他混杂因素后,SYNTAX评分每增加5分,糖尿病患者ISR的风险增加34%(HR=1.34,95%CI=1.03~1.74,P=0.031)。结论:对于冠心病合并2型糖尿病患者,SYNTAX评分是冠状动脉ISR的一个独立的危险因素,可以作为临床预测冠状动脉ISR的一个指标之一。

Objective： This study was to investigate the SYNTAX score significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent（ DES）. Methods：A total of 437 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Department of 12 th Ward,Beijing Anzhen Hospital in China were consecutively enrolled from Junuary 2012 to December 2012. Of these,382 patients underwent the second angiography within ≥6 months due to the progression of treated target lesions. Finally,368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. The severity of coronary artery lesions was quantified with Synergy Between PCI With Taxus and Cardiac Surgery（ SYNTAX） score,which was calculated using the online calculator for SYNTAX score. Results： A total of 368 patients（ 260 women and 108 men） with a mean ages of（ 58. 7 ±10. 3） years were enrolled in this study. Repeat angiography after baseline PCI was conducted with a mean time of（ 15. 85 ± 9. 18） months follow-up. Angiographyresult showed that ISR occurred in 74/368 diabetic patients（ 20. 11%）. In the multivariate Cox＇s proportional hazards regression,after adjusting for traditional risk factors,lipid profiles,angiographic factors,medical history,and other biomarkers,SYNTAX score（ per 5 increments,HR = 1. 34,95% CI = 1. 03-1. 74,P = 0. 031） was identified as the independent predictors associated with ISR in diabetic patients. Conclusion： The higher SYNTAX score was independent predictor of ISR in patients with DM after coronary DES implantation. It provided new evidence for physicians to take measures to lower the risk of ISR for the better management of diabetic patients after PCI.