老年冠心病合并糖尿病患者雷帕霉素洗脱支架置入术后5年随访研究

目的探讨老年冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入雷帕霉素洗脱支架（SES）治疗的远期疗效。 方法回顾性随机入选2003年1月至2007年12月住院期间老年冠心病合并糖尿病患者行PCI 100例，并入选同时期100例无糖尿病的冠心病患者行PCI为对照组。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果 两组支架术成功率均为100%。随访率100%，随访5年，糖尿病组与非糖尿病组术后并发症发生率（8.0%、7.0%）、卒中发生率（5%、3.0%）、心源性死亡率（0%、0%）差异无显著性（均为ρ〉0.05）。再次血运重建率（30.0%、14.0%）、非致死性心肌梗塞（6.0%、2.0%）心绞痛复发率（42%、20%）、全因死亡率（10%、2.0%）糖尿病组高于非糖尿病组；但心源性病死率均为0%。结论：老年患者选择性冠脉内置入药物洗脱支架安全，成功率高，远期疗效尚好，但糖尿病仍是远期不良预后的独立预测因素。

Five years follow up result after application of sirolimus-eluting stent in elderly patients with coronary heart diseaseand combined with diabetes mellitus

Objective： To assess the long-term clinical outcomes in patients with coronary artery disease combined with diabetes mellitus after sirolimus-eluting stent（SES） based percutaneous coronary intervention. Method： The lesion characteristics of coronary artery, the success rate of interventional procedures and incidence of major adverse cardiac cerebrovascular events （MACCE） were analyzed retrospectively and compared in elderly patients with coronary heart disease combined with （100 cases） or without （100 cases） type 2 diabetes mellitus. Results： SES were successfully implanted on target lesions in two gruops. Success rate and follow-up were 100%. The five years follow-up results showed there were no significant differences in complication rate（ 8.0% vs 7.0% ） , stroke （5.0%vs 3.0% ） （ all P 〉 0.05 ）. The rate of target vessel revascularization, non- fatal myocardial infarction and angina recurrence rate and mortality（30.0% ,6.0% ,42%, 10% ） were higher in the diabetics group than those in the non-diabetics group（ 14.0% ,2.0% ,20% ,2.0%, P 〈 0.05 ）. Cordially, ardiac death was zero in two groups. Conclusion： Implanting SES in patients with coronary artery disease combined with diabetes mellitus is safe and effective. Long-term outcomes is good,but diabetes mellitus is still independently associated with worse late prognosis.