合并糖尿病的冠状动脉粥样硬化性心脏病患者支架置入术后远期随访研究

Long-term outcomes after stent implantation in patients with coronary atherosclerotic heart disease and diabetes mellitus

目的:评价合并糖尿病的冠状动脉粥样硬化性心脏病(冠心病)患者接受支架置入术后的远期疗效。方法:入选2011年2月至12月行支架置入术的冠心病患者483例,分为糖尿病组(n=138),非糖尿病组(n=345)。所有患者至少随访5年,主要终点事件为全因死亡,复合终点为主要心血管不良事件(MACE),包括心肌梗死、靶血管重建、支架内再狭窄和死亡。结果:随访期间,糖尿病组发生心肌梗死6例、靶血管重建16例、支架内再狭窄6例、死亡12例、总MACE事件30例;非糖尿病组发生心肌梗死3例、靶血管重建21例、支架内再狭窄10例、死亡10例、总MACE事件37例。两组之间靶血管重建率及支架内再狭窄率无明显差异。Kaplan-meier法预测MACE发生率(22.2%对11.1%,P<0.05)和全因死亡率(8.9%对3.1%,P<0.05)糖尿病组均高于非糖尿病组。COX比例风险模型进行多因素分析结果显示,糖尿病是MACE发生(HR=3.02,95%CI:1.09~8.34,P<0.05)及全因死亡(HR=2.06,95%CI:1.12~3.79,P<0.05)的独立预测因素。结论:合并糖尿病的冠心病患者置入支架后的远期MACE事件发生率及死亡率均显著高于非糖尿病患者,糖尿病是影响冠心病预后的重要因素。

Objective：To assessthe long-term effect of coronary stent implantation in patients with diabetes mellitus. Methods：Four hundred and eighty-three coronary atherosclerotic heart disease（CHD）patients who received percutaneous coronary intervention（PCI）with coronary stent implantation were enrolled in from February to December 2011.Of all patients involved,138 were associated with diabetes mellitus（DM）and the others were non-diabetic.All patients were followed up for at least5 years.The primary endpoint event was all-cause death,and the secondary endpoint events was a composite end point of major adverse cardiovascular events（MACE）,including myocardial infarction（MI）,target vessel revascularization（TVR）,in-stent restenosis（ISR）and death. Results：During the follow-up period,there were 6 cases of MI,16 cases of TVR,6 cases of ISR,12 cases of death and30 cases of MACE in patients with DM and there were 3 cases of MI,21 cases of TVR,10 cases of ISR,10 cases of death and 37 cases of MACE in patients without DM.The rates of TVR and ISR were not significantly different between two groups.Kaplan-Meier method predicted a higher MACE rate（22.2%vs.11.1%,P〈0.05）and all-cause mortality（8.9% vs.3.1%,P〈0.05）in patients with DM thanthose without DM.Cox proportional hazards model identified diabetes as an independent predictor of the rate of MACE（HR=3.02,95%CI：1.09～8.34,P〈0.05）and all-cause mortality（HR=2.06,95%CI：1.12～3.79,P〈0.05）. Conclusions：Long-term outcomes after coronary stent implantation showed higher MACE rate and all-cause mortality in patients with DM than those without DM.Diabetes is an important factor influencing the prognosis of coronary heart disease.