空腹血糖水平与经皮冠状动脉介入治疗五年预后的关系

目的 了解老年冠心病患者经皮冠状动脉介入治疗(PCI)预后及相关危险因素,分析空腹血糖(FPG)水平与PCI术后冠状动脉再狭窄和心脏事件发生率的关系,为论证FPG受损(IFG)诊断标准提供相关心血管终点事件的依据.方法 选取2000年1月至2001年12月于解放军总医院成功接受PCI术的老年冠心病患者共269例,按照基线空腹血糖水平分为4组(组1:FPG<5.6mmol/L;组2:5.6 mmol/L≤FPG<6.1 mmol/L;组3:6.1 mmol/L≤FPG<7.0 mmoL/L;组4:FPG≥7.0mmol/L),随访时间为5年,进行PCI术后再狭窄、复发性心脏事件、生存率及相关危险因素的分析.结果 5年随访结束后5.6 mmol/L≤FPG<6.1 mmol/L人群总心脏事件发生率、再次血运重建率、心绞痛复发率以及再狭窄发生率显著高于FPG<5.6 mmol/L的人群(P均<0.05),而与6.1 mmol/L≤FPG<7.0 mmol/L人群比较差异无统计学意义.5年随访结束组2、3、4的无心脏事件的累积生存率显著低于组1(P均<0.05),组2、3之间差异无统计学意义.logistic回归模型结果 显示,水平是PCI术后再狭窄、心脏事件发生、全因死亡、心绞痛复发的危险因素(P均<0.05).结论 FPG 5.6 mmol/L以上的老年冠心病人群PCI术后5年冠状动脉再狭窄及不良心脏事件发生率已开始显著升高,无心脏事件累积生存率显著降低.因此从改善心血管预后角度看,将IFG的下限调整到5.6 mmol/L具有合理性.

Association between fasting plasma glucose and the 5 years outcome post PCI in aged patients with coronary artery disease

Objective To observe the association between fasting plasma glucose (FPG) and 5 years outcome post PCI in aged patients with coronary artery disease (CAD). Methods A total of 269 patients (mean age 63.8±9.4 years, 236 males) with CAD underwent PCI between January 2000 and December 2001 were followed up and data on angiographic restenosis, the major adverse cardiac events, the cumulative survival rates and the correlated risk factors were collected and analyzed. Patients were divided into 4 groups according to the levels of their FPG at baseline (group 1:FPG < 5.6 mmol/L; group 2:5. 6 mmol/L≤FPG <6. 1 mmol/L;group 3:6. 1 mmol/L≤FPG <7.0 mmol/L;group 4:FPG≥7.0 mmol/L). Results At the end of the 5 years follow-up, the incidences of major adverse cardiac events, target lesion revascularization, recurring angina pectofis and angiographic restenosis of group 2 were significantly higher than those of group 1 (P < 0. 05) and similar as those in group 3 (P 0.05). The cumulative survival rates of cardiovascular events of group 2, group 3 and group 4 were all significantly decreased compared with group 1 ( P < 0. 05 ). The logistic regression model analysis showed that FPG was an independent risk factor for angiographic restenosis, incidence of major adverse cardiac events, all-cause mortality and recurring angina pectoris (P < 0. 05 ). Conclusion FPG≥5.6 mmol/L and over is associated with increased incidences of major adverse cardiac events in aged patients with CAD who underwent PCI.