糖尿病患者冠状动脉内支架术后的远期疗效

目的　探讨糖尿病患者选择性冠状动脉 (冠脉 )内支架术的远期疗效。方法　 80 8例冠心病患者行选择性冠脉内支架术 ,其中糖尿病组 174例 ,非糖尿病组 6 34例。随访两组患者远期结果。结果　两组支架术成功率 (96 0 %和 96 1% )相似。平均随访 (19± 7 8)个月 (6～ 4 2个月 ) ,临床随访率为 95 3%。随访期内 ,与非糖尿病组相比 ,糖尿病组心功能改善者 (5 2 2 %比 6 1 0 % )较少 ,再住院率 (4 2 7%比 32 5 % )增加 ;且心脏事件 (30 6 %比 2 2 2 % )、再狭窄 (19 1%比 12 5 % )及总死亡(10 2 %比 4 6 % )均显著增加。多因素分析显示 ,糖尿病为死亡 (OR =2 2 0 ,95 %CI 1 12～ 4 33,P =0 0 2 2 )和再狭窄 (OR =1 6 6 ,95 %CI 1 0 4～ 2 6 7,P =0 0 35 )的独立预测因素。结论　糖尿病患者选择性冠脉内支架术远期结果可以接受 ,但糖尿病仍是远期不良预后的独立预测因素。

Long-term outcomes after elective coronary stenting in diabetic patients

OBJECTIVE: To observe the long-term outcomes following coronary stenting in diabetic patients with coronary artery disease. METHODS: This cohort study comprised 808 consecutive patients with coronary artery disease who underwent elective coronary stenting, including 174 diabetic patients and 634 non-diabetic patients. The long-term follow-up outcomes were compared. RESULTS: Procedural success rate was similar (96.0% vs 96.1%). Follow-up rate was 95.3%. Mean follow-up duration was (19 +/- 7.8) months (ranged from 6 to 42 months). Compared with non-diabetic patients, diabetic patients had less improvement of cardiac function (52.2% vs 61.0%), more re-admission (42.7% vs 32.5%), and higher occurrence rates of major adverse cardiac events (30.6% vs 22.2%), angiographic restenosis rate (19.1% vs 12.5%) and mortality (10.2% vs 4.6%). Logistic regression analysis indicated that diabetes mellitus was an independent predicator of death (odd ratio 2.20, 95% CI 1.12 approximately 4.33, P = 0.022) and restenosis (odd ratio 1.66, 95% CI 1.04 approximately 2.67, P = 0.035). CONCLUSION: Diabetic patients undergoing elective coronary stenting have acceptable long-term outcomes, but diabetes mellitus is still independently associated with worse late prognosis.