糖尿病对心房颤动合并冠状动脉支架植入后患者预后的影响

Effect of diabetes on prognosis of patients with atrial fibrillation and coronary stent implantation

目的探讨糖尿病对心房颤动(AF)合并冠状动脉支架植入后患者预后的影响。方法采用检索电子病历库方式,筛选出北京12家三级医院2010年1月至2015年1月收治的心房颤动合并急性冠脉综合征并行经皮冠状动脉介入治疗(PCI)的患者,采用电话或门诊方式对患者进行定期随访。收集符合入选标准患者2206例,平均随访时间为(3.33±1.46)年,排除失访患者,实际纳入患者1975例,进一步分组为糖尿病组(610例)和非糖尿病组(1365例)。对比分析两组患者基线资料、既往病史、临床检验检查等情况,随访截止至2016年3月。记录缺血性脑卒中、主要不良心血管事件(MACE)及出血事件发生情况。绘制不同终点事件的Kaplan-Meier生存曲线比较,并采用Log-rank法进行检验。结果糖尿病组缺血性脑卒中发生率7.0%、MACE发生率25.4%、全因死亡率14.5%,非糖尿病组缺血性脑卒中发生率4.8%、MACE发生率20.5%、全因死亡率10.1%,两组差异有统计学意义(P<0.05);糖尿病组出血事件发生率7.3%,非糖尿病出血事件发生率8.9%,两组差异无统计学意义(P>0.05)。结论合并糖尿病的心房颤动伴PCI后患者有更高的缺血性脑卒中风险及病死率;糖尿病不增加心房颤动合并PCI后患者出血事件发生风险。

Objective To investigate the effect of diabetes mellitus(DM)on the prognosis of patients with atrial fibrillation(AF)complicated with coronary artery stent implantation.Methods By retrieving electronic medical records,patients who had atrial fibrillation combined with acute coronary syndrome underwent Percutaneous Coronary Intervention(PCI)were screened from 12 tertiary hospitals in Beijing from January 2010 to January 2015,regular follow-up were carried out with patients by telephone or outpatient.2206 patients were recruited according to inclusion criteria,with an average follow-up time of(3.33 to 1.46)years.After excluding missing patients,and the actual inclusion number of patients was 1975 cases,who were further divided into diabetes group(610 cases)and non-diabetic group(1365 cases).Baseline data,past history,and clinical examination results were compared in two groups.Then GRACE score,CRUSADE score,CHA2DS2-VASc score,HAS-BLED score were performed according to the defined scoring criteria,and the follow-up end up on March 2016.Incidence of ischemic stroke,major adverse cardiovascular events(MACE),and bleeding were recorded in each patients.Kaplan-Meier survival curves for different endpoint events was plotted and then compared by the Log-rank method.Results In the diabetes group,incidence of ischemic stroke was 7.0%,incidence of MACE was 25.4%,all-cause mortality was 14.5%.In non-diabetic group,the incidence of ischemic stroke,incidence of MACE and all-cause mortality was 4.8%,20.5%and 10.1%,respectively.The differences between the two groups were statistically significant(P<0.05).The rate of bleeding events was 7.3%in the diabetic group and 8.9%in non-diabetic group.There was no statistically significant difference between the two groups(P>0.05).Conclusion The diabetic patients with atrial fibrillation and PCI surgery had a higher risk and mortality rate of ischemic stroke.Diabetes does not increase the risk of bleeding events in patients with atrial fibrillation and PCI surgery.