经皮冠状动脉介入治疗血运重建对慢性完全性闭塞病变合并糖尿病患者临床预后的回顾性分析

Influence of percutaneous coronary intervention for revascularization on clinical prognosis in patients with chronic total occlusion lesions complicated by diabetes:A retrospective analysis

目的慢性完全性闭塞病变(CTO)的介入治疗预后结论尚不一致,尤其是对于合并糖尿病的患者,开通CTO病变后的预后仍在探讨中,本研究旨在回顾性分析本病区糖尿病合并CTO患者,对比成功开通CTO病变与药物治疗对患者预后的影响。方法本研究回顾性纳入首都医科大学附属北京安贞医院心内科于2015年2月至2022年3月收治的慢性完全闭塞病变合并糖尿病患者170例,其中成功开通CTO者122例,药物治疗48例。随访中位时间为28.50月。主要终点为主要不良心血管事件(MACE):心源性死亡,非致死性心肌梗死,非计划性血运重建,支架内再狭窄,心力衰竭及脑卒中。比较两组治疗前后左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)变化。结果总体MACE发生率为22.9%(39/170)。成功开通CTO组MACE发生率为23.8%(29/122);药物治疗组MACE发生率为20.8%(10/48)。Kaplan-Meier生存曲线显示,成功开通CTO病变未减少患者MACE发生(Log-rank=0.375,P=0.540)。多因素Cox回归分析显示,开通CTO未减少患者MACE发生(HR=1.452,95%CI:0.649~3.250,P=0.364)。CTO开通后与开通前相比,LVEF[(60.460±7.623)%vs.(60.160±8.119)%]、LVEDD[(47.800±5.606)mm vs.(49.236±5.491)mm]、LVESD[(32.850±6.144)mm vs.(33.389±7.059)mm]均无统计学差异。药物治疗后与治疗前相比,LVEF[(60.690±6.226)%vs.(63.750±6.506)%]、LVEDD[(49.250±3.890)mm vs.(48.813±2.762)mm]、LVESD[(33.130±3.907)mm vs.(32.000±4.226)mm]均无统计学差异。结论本单中心研究中,与药物治疗相比,未观察到介入治疗开通CTO病变进一步减少MACE及对心功能的改善。

Objective The prognosis of percutaneous coronary intervention for the patients with chronic total occlusive(CTO-PCI)lesions remains inconsistent,especially for CTO patients complicated by diabetes mellitus(CTO+DM),and the prognosis after CTO-PCI has been under investigation.The study was to retrospectively analyze CTO patients complicated by diabetes,and compare the influence of CTO-PCI and medication on prognosis.Methods The patients with CTO+DM(n=170)were respectively chosen from Department of Cardiology in Beijing Anzhen Hospital affiliated to Capital Medical University from Feb.2015 to Mar.2022,among them there were 122 patients with successful CTO-PCI(CTO-PCI group)and 48 patients treated with drugs(mediation group).The median duration of follow-up was 28.50 months.The primary endpoints were major adverse cardiovascular events(MACE),including cardiac death,non-fatal myocardial infarction,unplanned revascularisation,in-stent restenosis,heart failure and stroke.The changes of left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)were compared between 2 groups before and after treatment.Results The total incidence of MACE was 22.9%(39/170).The incidence of MACE was 23.8%(29/122)in CTO-PCI group and 20.8%(10/48)in medication group.The results of Kaplan-Meier survival curve analysis showed that CTO-PCI did not reduce MACE occurrence(Log-rank=0.375,P=0.540).The results of multi-factor Cox regression analysis showed that CTO-PCI did not reduce MACE occurrence(HR=1.452,95%CI:0.649~3.250,P=0.364).The comparison before and after CTO-PCI showed that LVEF[(60.460±7.623)%vs.(60.160±8.119)%],LVEDD[(47.800±5.606)mm vs.(49.236±5.491)mm]and LVESD[(32.850±6.144)mm vs.(33.389±7.059)mm]had no statistical differences.The comparison before and after medication showed that LVEF[(60.690±6.226)%vs.(63.750±6.506)%],LVEDD[(49.250±3.890)mm vs.(48.813±2.762)mm]and LVESD[(33.130±3.907)mm vs.(32.000±4.226)mm]had no statistical differences.Conclusion In this single-center study,no further reduction in MACE and improvement in heart function are observed in CTO-PCI group compared with medication group.