糖尿病多支冠状动脉病变患者不同血管重建疗效的比较

目的:评价对糖尿病多支冠状动脉病变患者的裸支架(BMS)置入、药物洗脱支架(DES)置入和冠状动脉搭桥手术(CABG)3种不同血管重建的疗效。方法:选择接受血管重建治疗的糖尿病伴多支冠状动脉病变患者427例,比较其BMS、DES和CABG不同治疗方法的疗效和随访2年的临床结果。结果:BMS、DES和CABG3组间住院时期的不良心脑血管事件(MACCE)发生率比较,差异均无统计学意义。2年随访结果中,BMS组、DES组再次血管重建率分别为17.6%、10.4%,均显著高于CABG组的1.9%(P<0.01);BMS组的总MACCE发生率为23.1%,显著高于CABG组的10.7%(P<0.01),而DES的总MACCE发生率与CABG组相比差异无统计学意义。结论:糖尿病多支血管病变患者置入BMS后再次血管重建率和总MACCE发生率显著高于CABG,而DES的中期临床疗效并不逊于CABG。

Evaluation of different revascularization strategies in diabetic patients with multivessel abnormalities

Objective:The study aims to evaluate three revascularization strategies,including bare metal stent(BMS)implantation,drug eluting stent(DES)implantation and coronary artery bypass surgery(CABG)in diabetic patients with multivessel abnormalities.Method:Four hundred and twenty-seven patients with diabetes and multivessel abnormalities who underwent the revascularization in our institution were enrolled to compare their clinical outcomes during hospitalization and 2-year followup among BMS,DES and CABG groups.Result:No statistical differences are found in the rate of in-hospital major adverse cardiac and cerebrovascular events(MACCE)among the BMS,DES and CABG groups.During 2-year follow up,the rate of repeat revascularization in BMS group was 17.6% and MACCE was 23.1%,which were much higher than those of DES and CABG groups.The risk of repeat revacularization in BMS group was 16.858(95% CI 4.079-69.677,P<0.01)times that of the CABG group,and the risk of MACCE is 3.484(95% CI 1.565-7.753,P<0.01)times that of the CABG group.The 2-year followup event-free survival of BMS group was much lower than that of CABG group.In the DES group,the rate of repeat revascularization was 10.4%,which was much lower than that of the BMS group but still higher than that of the CABG group.No differences were found in the rates of 2-year followup MACCE and event-free survival between DES and CABG groups.Conclusion:The intermediate clinical outcomes of drug eluting stent implanation was not inferior to coronary bypass surgery for diabetic patients with multivessel diseases.