高龄老年急性冠脉综合征合并糖尿病患者不同血运重建的预后分析

Prognosis of different revascularizations in elderly patients with acute coronary syndrome complicated by diabetes

目的探讨高龄老年糖尿病合并急性冠脉综合征(ACS)多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)完全(CR)及不完全血运重建(IR)方式对预后的影响。方法回顾性分析2012年6月至2019年12月期间于河南中医药大学附属郑州人民医院接受PCI治疗的糖尿病ACS合并MVD高龄老年患者229例,根据患者接受PCI血运重建方式分为:CR组(92例)和IR组(137例)。分析3年随访主要终点事件(全因死亡、心源性死亡、心肌梗死);次要终点事件为主要不良心脑血管事件(MACCE)的复合终点事件。结果3年随访期内主要终点事件:IR组全因死亡(18.25%vs.8.69%,P=0.044)、心源性死亡(16.79%vs.7.61%,P=0.044)、心肌梗死(8.33%vs.5.43%,P=0.021),显著高于CR组;次要终点事件:IR组总MACCE事件(56.20%vs.21.73%,P=0.000)、缺血驱动的再次血运重建(18.98%vs.2.24%,P=0.001)、心绞痛复发率(24.09%vs.7.61%,P=0.001)和再次住院率(91.97%vs.13.13%,P=0.000)显著高于CR组。结论高龄老年ACS合并糖尿病MVD患者CR可减少术后MACCE发生率。

Objective To discuss the influence of complete revascularization(CR)and incomplete revascularization(IR)on prognosis in elderly patients with acute coronary syndrome-multi-vessel disease(ACSMVD)complicated by diabetes after percutaneous coronary intervention(PCI).Methods The elderly patients with ACS-MVD complicated by diabetes(n=229)received PCI were retrospectively analyzed in Zhengzhou People’s Hospital affiliated to Henan University of Traditional Chinese Medicine from June 2012 to Dec.2019.All patients were divided,according to revascularization types of PCI,into CR group(n=92)and IR group(n=137).The main end-point events(all-cause death,cardiac death,myocardial infarction)were analyzed in 3-y follow-up period,and secondary end-point events were composite end-point events of major adverse cardiovascular and cerebrovascular events(MACCE).Results The incidence rates of main end-point events were significantly higher in IR group than those in CR group,including all-cause death(18.25%vs.8.69%,P=0.044),cardiac death(16.79%vs.7.61%,P=0.044)and myocardial infarction(8.33%vs.5.43%,P=0.021).The incidence rates of secondary end-point events were significantly higher in IR group than those in CR group,including MACCE(56.20%vs.21.73%,P=0.000),ischemia-driven revascularization(18.98%vs.2.24%,P=0.001),angina recurrence rate(24.09%vs.7.61%,P=0.001)and readmission rate(91.97%vs.13.13%,P=0.000).Conclusion The incidence of MACCE can be reduced by CR in elderly patients with ACS-MVD complicated by diabetes.