不同血运重建方式对冠心病合并糖尿病患者近期和远期临床结果的影响Short-term and long-term outcomes of different revasularizaton strategies in coronary heart disease patients with diabetes mellitus
吕强,马长生,康俊萍,聂绍平,杜昕,胡荣,刘新民,贺立群,张崟,董建增,刘小慧,顾承雄,黄方炯,吕树铮,吴学思
摘要(Abstract)：
目的比较在广泛使用药物涂层支架(drug-eluting stent,DES)的时代,不同血运重建方式对冠心病合并糖尿病患者近期和远期临床结果的影响。方法DESIRE(Drug-Eluting Stent Im-pacton Revascularization)为单中心回顾性注册研究,入选了两个不同时间段即非DES时代及DES时代接受血运重建治疗的3763例患者。本研究选取DES时代的冠心病合并糖尿病患者670例(包括既往有糖尿病病史者和本次入院新诊断糖尿病者),根据血运重建方式分为经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)组和冠状动脉旁路移植术(coronary artery bypass graft,CABG)组。不良心血管事件定义为全因死亡、致死/非致死性心肌梗死、致死/非致死性卒中或再次血运重建的复合终点。结果两组基线情况无明显差异。PCI组的院内不良心血管事件低于CABG组(0.5%比4.1%,P=0.001),主要为死亡率较低(0.5%比3.3%,P=0.012)。PCI组和CABG组分别随访592.6±121.3d及581.5±148.3d,两组随访率相似(92%比89.7%,P=0.311),两组远期不良心血管事件差异无统计学意义,PCI组有增高趋势(14.2%比9.0%,P=0.056),主要为再次血运重建的患者较多(8.5%比2.1%,P=0.001),随访中死亡、非致死性心肌梗死和非致死性卒中的发生率相似。结论在广泛使用DES的时代,行PCI的冠心病合并糖尿病患者院内不良心血管事件发生率低于CABG,主要为院内死亡率低。两组远期不良心血管事件发生率差异无统计学意义,但PCI组的再次血运重建率较高。
关键词(KeyWords)： 血管成形术,经腔,经皮冠状动脉;支架;冠状动脉分流术;冠状动脉疾病;糖尿病;治疗结果
基金项目(Foundation): 国家重点基础研究发展计划(973计划)项目(2003CB517103)
作者(Author): 吕强,马长生,康俊萍,聂绍平,杜昕,胡荣,刘新民,贺立群,张崟,董建增,刘小慧,顾承雄,黄方炯,吕树铮,吴学思
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