冠状动脉慢性完全闭塞合并糖尿病患者的血运重建策略探讨

Discussion on the revascularization strategies in patients with chronic total occlusion of coronary artery and diabetes mellitus

目的 探讨冠状动脉慢性完全闭塞(CTO)合并糖尿病患者不同血运重建策略的临床预后。方法 本研究入选2007年1月1日至2017年12月31日于首都医科大学附属北京安贞医院住院治疗的冠状动脉CTO合并糖尿病患者,根据血运重建策略不同将患者分为CTO-S-经皮冠状动脉介入(PCI)组(成功CTO-PCI患者)和CTO-S-冠状动脉旁路移植术(CABG)组(成功CTO-CABG患者)。主要终点为主要不良心血管事件(MACE)复合终点。其他结局指标包括全因死亡和再灌注。比较2组临床结局。结果 本研究共纳入1 062例患者,其中CTO-S-PCI组683例,CTO-S-CABG组379例。在主要终点MACE方面,CTO-S-CABG组优于CTO-S-PCI组[6.1%(23/379)比20.8%(142/683)](P<0.05)。该优势在靶血管再灌注、再发非致死性心肌梗死及再灌注方面是一致的。但在心源性死亡及全因死亡方面,2组间差异均无统计学意义(均P>0.05)。结论 对于冠状动脉CTO合并糖尿病患者,CABG优于PCI,可减少MACE的发生。

Objective To investigate the clinical outcomes of different revascularization strategies in patients with chronic total occlusion(CTO) and diabetes mellitus.Methods Patients with CTO and diabetes mellitus hospitalized in Beijing Anzhen Hospital,Capital Medical University from January 1,2007 to December 31,2017 were enrolled in this study.The patients were divided into CTO-S-percutaneous coronary intervention(PCI) group(successful CTO-PCI patients) and CTO-S-coronary artery bypass grafting(CABG) group(successful CTO-CABG patients) according to the different revascularization strategies.The primary endpoint was a composite endpoint of major adverse cardiovascular events(MACE).Other outcome measures included death from any cause and reperfusion.The clinical outcomes were compared between the two groups.Results A total of 1 062 patients were included in this study,including 683 in the CTO-S-PCI group and 379 in the CTO-S-CABG group.In terms of MACE,the CTO-S-CABG group was better than the CTO-S-PCI group [6.1%(23/379) vs 20.8%(142/683)](P<0.05).This advantage was consistent with target-vessel reperfusion,recurrent nonfatal myocardial infarction,and reperfusion.However,there was no significant difference in cardiac death and all-cause death between the two groups(all P>0.05).Conclusion For patients with CTO and diabetes mellitus,CABG is superior to PCI and can reduce the incidence of MACE.