高压球囊后扩张对2型糖尿病合并冠心病并行DES植入患者近期预后的影响

Influence of hyperbaric post-balloon dilation on short term prognosis of intracoronary drug-eluting stent implantation in patients with type 2 diabetes mellitus complicating coronary artery disease

目的探讨2型糖尿病合并冠心病患者在冠状动脉药物洗脱支架(DES)植入后使用非顺应性球囊行后扩张治疗的近期临床疗效和安全性。方法回顾性分析2014年1月至2016年6月该院行冠状动脉介入治疗(PCI)的2型糖尿病合并冠心病(除外急性心肌梗死病例)患者82例,根据DES支架植入后是否采用非顺应球囊后扩张分为后扩张组及非后扩张组。比较两组患者的临床特征,糖化血红蛋白,手术入路,冠状动脉病变情况,DES植入情况,术中TIMI血流,住院期间急性和亚急性血栓、恶性心律失常,住院期间和PCI术后9个月的出血事件、主要心脏不良事件(MACE)、左室射血分数及PCI术后9个月的晚期血栓发生、支架内再狭窄。结果后扩张组手术时间[(1.45±0.38)h]大于非后扩张组[(1.27±0.33)h](P<0.05),住院期间急性和亚急性血栓发生率和MACE发生率低于非后扩张组(P<0.05)。后扩张组PCI术后9个月的支架内再狭窄率低于非后扩张组(P<0.05)。结论对2型糖尿病合并冠心病患者在DES植入后使用非顺应性球囊行后扩张治疗安全,可改善患者临床预后。

Objective To investigate the short term clinical efficacy and safety of non-compliant postballoon dilation after implantation of intracoronary drug-eluting stent（DES）in the patients with type 2 diabetes mellitus（T2 DM）complicating coronary artery disease（CAD）.Methods Eighty-two patients with T2 DM and CAD（excluding the cases of acute myocardial infarction）treated by PCI in this hospital from January2014 to June 2016 were retrospectively analyzed and divided into the postdilatation group and non-postdilatation group according to whether adopting non-compliant post-balloon dilation after DES implantation.Clinical features,glycosylated hemoglobin,operative approach,coronary arterial lesions,implantation of DES,intraoperative TIMI blood flow,acute and subacute thrombosis,malignant arrhythmia during hospitalization period and hemorrhage events,major adverse cardiac events（MACE）,left ventricular ejection fraction（LVEF）during hospitalization period and postoperative 9 months,late thrombus occurrence and intra-stent re-stenosis in 9 months after PCI were compared between the two groups.Results The operation time in the postdilatation group was（1.45±0.38）h,which was significantly higher than（1.27±0.33）h in the non-postdilation group.The occurrence rate of acute and sub-acute thrombus and occurrence rate of MACE during hospitalization period were lower than those in the non-postdilation group（P〈0.05）.The occurrence rate of intra-stent restenosis at 9 months after PCI in the postdilation group was lower than that in the non-postdilation group（P〈0.05）.Conclusion Postdilatation with non-compliant balloons after DES implantation is safe and could improve the clinical prognosis in the patients with T2 DM complicating CAD.