血运重建优化策略对老年T2DM合并ACS冠脉多支病变患者预后的影响

目的 探讨血运重建优化策略对老年2型糖尿病（T2DM）合并急性冠脉综合征（ACS）冠脉多支病变（MVD）患者预后的影响。方法 根据不同血运重建策略将2015年1月至2016年5月行经皮冠脉介入术（PCI）的95例老年T2DM合并ACS的MVD患者分为完全血运重建（CR）组与部分血运重建（IR）组。比较两组基线资料、冠脉造影结果、介入治疗情况、术后1年主要心血管不良事件（MACE）及生活质量的差异。结果 两组性别、年龄、吸烟史、高血压病史、高脂血症病史、药物使用情况、冠脉造影结果比较差异均无统计学意义（P>0.05）；CR组置入支架数多于IR组（P<0.05）；术后1年全因死亡、心源性死亡、再次血运重建、非致死性心肌梗死发生率两组比较差异无统计学意义（P>0.05），CR组心绞痛复发率低于IR组（P<0.05）；CR组总体健康、生理功能、生理职能、躯体疼痛、社会功能、情感职能、活力、精神健康差值（术后1年数值-术前数值）均高于IR组（P<0.05）。结论 IR和CR对老年T2DM合并ACS的MVD患者预后相当，但CR对改善心绞痛症状和提高患者生活质量较优。

Effects of revascularization optimization strategy on prognosis of elderly patients with T2DM complicated with ACS and coronary multivessel disease

Objective To explore the effects of revascularization optimization strategy on the prognosis of elderly patients with type 2 diabetes mellitus (T2DM) complicated with acute coronary syndrome (ACS) and coronary multivessel disease (MVD). Methods According to different revascularization strategies, 95 elderly MVD patients with T2DM and ACS who underwent percutaneous coronary intervention (PCI) from Jan 2015 to May 2017 were divided into complete revascularization group (CR group) and partial revascularization group (IR group). Baseline data, coronary angiography results, interventional therapy, major cardiovascular adverse events (MACE) and quality of life within one year after operation were compared between the two groups. Results here were no significant difference in the gender, age, smoking history, history of hypertension, history of hyperlipidemia, drug use and coronary angiography results between the two groups (P>0.05). The number of inserted stents in CR group was higher than that in IR group (P<0.05). There were no significant difference in the incidence rates of all-cause mortality, cardiac death, repeat revascularization and nonfatal myocardial infarction between the two groups (P>0.05). The recurrence rate of angina in CR group was lower than that in IR group (P<0.05). The scores of physical function, role physical, physical pain, emotional function, vitality and mental health in CR group were significantly higher than those in IR group (P<0.05).Conclusion IR and CR have the similar prognosis for elderly MVD patients with T2DM and ACS, but CR is better for improving angina symptoms and improving patients'' quality of life.