糖尿病对选择性经皮冠状动脉介入治疗操作及住院期临床事件的影响

目的　比较冠心病合并与不合并糖尿病的患者选择性经皮冠状动脉介入治疗 (PCI)操作及住院期临床事件发生率,分析糖尿病对选择性PCI操作及住院期临床事件的影响。方法　对2002年 1月至 12月在本院连续进行的全部 1294例选择性PCI并置入支架的患者进行回顾性分析,搜集患者临床资料、介入治疗操作技术特点、住院期间各项预后事件。计算PCI操作成功率、支架置入成功率以及临床成功率,用逐步logistic回归模型分析糖尿病对急性期临床事件的影响。结果　糖尿病患者占总体的 20 .8%,糖尿病患者C型病变、双支、三支病变发生率明显高于非糖尿病者 (P<0 .05)。糖尿病组术前狭窄程度、预扩张球囊平均长度、最大直径、最大充盈压力以及最长充盈时间均显著大于非糖尿病组[分别为 (91 .00±6 .62)%对 (89 .81±6 .64)%, (17. 07±6. 31)mm对 (16 .07±7 .28)mm, (2 .30±1 .11)mm对(2 .12±0 .94)mm, (9 .86±4 .40)atm对(9 05±4 75)atm, (20 .94±14 .69)s对(18. 26±14 .65)s,P<0 .05],而所置入支架平均直径较小 [ ( 3 .15±0 .47 )mm对 ( 3 .23±0. 43)mm,P<0. 05]。糖尿病组与非糖尿病组之间的PCI操作成功率、临床成功率差异无统计学意义(分别为 89 6%对 90 .3%, 99 .3%对 99 .2%,P>0. 05),糖尿病不是发生急性期终

The influence of diabetes mellitus on the procedural and in-hospital outcomes after selective percutaneous coronary intervention

OBJECTIVE: To compare the procedural and in-hospital outcomes in a large series of diabetic and non-diabetic patients undergoing selective percutaneous coronary intervention (PCI) and to evaluate the influence of diabetes mellitus on the procedural and in-hospital outcomes. METHODS: 1294 consecutive patients underwent selective PCI from January to December 2002 in this institution were analyzed retrospectively. Baseline clinical, in-lab and in-hospital outcome information were recorded. Rates of procedural success, device success and clinical success were analyzed and logistic regression was performed to model the association between diabetes status and outcomes. RESULTS: Two hundred and sixty-nine patients (20.8%) complicated with diabetes. Type C lesion, double and triple vessel diseases were more prevalent in diabetics than those in non-diabetics. The pre-PCI diameter stenosis of diabetics was significantly more severe than that of non-diabetics (91.00 +/- 6.62 vs 89.81 +/- 6.64, P < 0.01). The balloon length, maximum balloon diameter and maximum balloon inflation pressure, maximum inflation duration were larger in diabetics than those in non-diabetics [(17.07 +/- 6.31) mm vs (16.07 +/- 7.28) mm, (2.30 +/- 1.11) mm vs (2.12 +/- 0.94) mm, (9.86 +/- 4.40) atm vs (9.05 +/- 4.75) atm, (20.94 +/- 14.69) s vs (18.26 +/- 14.65) s, respectively, P < 0.05]. The stent diameter was smaller in diabetics than that in non-diabetics [(3.15 +/- 0.47) mm vs (3.23 +/- 0.43) mm, P < 0.05]. The procedural success rate showed no significant difference between two groups (89.6% vs 90.3%, P > 0.05). But a higher incidence of acute/subacute stent thrombosis was observed in diabetics compared with that in non-diabetics (1.9% vs 0.5%, P < 0.05). The rate of clinical success was similar between diabetics and non-diabetics (99.3% vs 99.2%, P > 0.05). Diabetes was not an independent predictor of acute outcomes in the regression model. CONCLUSIONS: A higher incidence of acute/subacute stent thrombosis was observed in diabetics. The incidence of procedural and in-hospital major adverse cardiac events and the rate of clinical success were similar between diabetics and non-diabetics. Diabetes was not an independent predictor of in-hospital outcomes after selective PCI.