ST段抬高型心肌梗死合并2型糖尿病患者行直接经皮冠状动脉介入术临床特点分析

Clinical characteristics of PCI in patients with type 2 diabetes with ST-segment elevation myocardial infarction

目的探讨ST段抬高型心肌梗死合并2型糖尿病患者行直接经皮冠状动脉介入术的临床特点。方法收集全军心血管介入诊疗管理系统数据库中自2010年10月1日至2013年12月31日收治的8 878例行直接经皮冠状动脉介入术的ST段抬高型心肌梗死患者的临床资料。按照是否患有糖尿病,将患者分别纳入糖尿病组(n=1 587)和非糖尿病组(n=7 291)。比较两组患者的基线资料、冠状动脉病变和直接经皮冠状动脉介入术的特点,以及围术期情况。结果糖尿病组中,女性,有冠心病家族史和心肌梗死史,心功能≥Ⅲ级,患有高血脂症、高血压病、肾功能不全、脑血管病、外周血管病的患者比例均高于非糖尿病组,差异有统计学意义(P <0. 05);多支血管病变、罪犯血管为右冠状动脉的患者比例高于非糖尿病组,单支血管病变、桡动脉入路、罪犯血管为左前降支和左回旋支的患者比例低于非糖尿病组,差异有统计学意义(P <0. 05);术后死亡、院内死亡、急/亚急性支架血栓的发生比例均高于非糖尿病组,差异有统计学意义(P <0. 05)。结论与非糖尿病患者比较,合并糖尿病的ST段抬高型心肌梗死患者的冠状动脉病变程度更重,围术期病死率更高,需要更加优化治疗策略,改善患者预后。

Objective To investigate the clinical features of the patients with type 2 diabetes mellitus(DM)with ST-segment elevation myocardial infarction(STEMI)undergoing direct percutaneous coronary intervention(PCI).Methods A retrospective was performed on 8 878 patients with STEMI and PCI from the databases of cardiovascular intervention management system and divided them into the DM group(n=1 587)and non-diabetes(nDM)group(n=7 291)according to whether DM was diagnosed.The baseline data,the characteristics of coronary artery disease and direct percutaneous coronary intervention were compared between the two groups,as well as the perioperative status.Results In the DM group,the incidence of female,with family history of coronary heart disease and myocardial infarction,cardiac function≥gradingⅢ,hyperlipidemia,hypertension,renal insufficiency,cerebrovascular disease and ratio of peripheral vascular disease were all higher than those in the nDM group,and the difference was statistically significant(P<0.05);the proportion of multi-vessel lesions and right coronary artery of criminal vessels was higher than that of nDM group,and the proportion of single-vessel lesions,PCI via the radial approach,left anterior descending branch and left circumflex branch of criminal vessels was lower than that of nDM group,with statistically significant differences(P<0.05);the incidence of postoperative death,in-hospital mortality and acute/subacute stent thrombosis was higher than that of nDM group,and the difference was statistically significant(P<0.05).Conclusion Compared with nDM patients,STEMI patients with DM have more risk factors for coronary heart disease,more severe coronary lesions,and higher perioperative mortality.It is necessary to optimize treatment strategies and improve their prognosis.