二代支架时代数据中糖尿病对无保护左主干患者不同血运重建术预后的影响

目的:在二代支架时代,糖尿病对不同血运重建策略治疗无保护左主干冠状动脉疾病患者的影响尚未可知。方法:回顾性入选823例无保护左主干冠状动脉疾病的患者,其中接受二代药物洗脱支架(DES)置入治疗的患者331例(糖尿病患者,n=99;非糖尿病患者,n=232),接受冠状动脉旁路移植术(CABG)患者492例(糖尿病患者,n=127;非糖尿病患者,n=365)。我们根据不同的血运重建策略比较了糖尿病对临床结果的影响。结果:在接受血运重建的无保护左主干病变患者中,糖尿病患者占27.5%(226/823)。经过平均25.3个月的随访后发现,在接受DES治疗的人群中,糖尿病患者与非糖尿病患者的全因死亡率、心源性死亡率、血运重建发生率、卒中和主要不良心脑血管事件的发生率没有显著差异。然而,在全因死亡/心肌梗死/卒中联合终点(糖尿病组21.5%vs.非糖尿病7.2%,P=0.001)及心肌梗死发生率(糖尿病组15.4%vs.非糖尿病组1.6%,P<0.001)中,糖尿病患者明显高于非糖尿病患者。在接受CABG治疗的群体中,糖尿病组和非糖尿病组所有临床终点发生率相似。结论:在二代药物洗脱支架治疗无保护左主干病变的患者中,合并糖尿病的患者较非糖尿病组预后较差,在接受CABG的患者中,糖尿病和非糖尿病组预后相似。

Outcomes of patients with unprotected left main coronary artery disease and diabetes after revascularization

Objective: Whether the effect of diabetes on patients with unprotected left main coronary artery(LMCA) disease differs according to different strategy of revascularization in the era of the second-generation drug-eluting stents(DES) was unknown. Methods: 823 consecutive patients having unprotected LMCA disease, who received the second-generation DES(n=331)(DM,n=99;non-DM,n=232) implantation or underwent CABG(n=492)(DM,n=127;non-DM,n=365)were prospectively enrolled. We compared the effects of diabetes on clinical outcomes according to different strategy of revascularization.Results: Among 823 eligible patients enrolled, 226 had diabetes. During a median follow-up of 25.3 months, no significant differences were observed in occurrences of death, cardiac death, repeat revascularization, stroke and MACCE in the DES population. However, the risks of the composite of death/MI/stroke(21.5% DM vs. 7.2% no-DM,P =0.001) and MI(15.4 % DM vs. 1.6% no-DM,P=0.000) were significantly higher in the diabetic patients compared with those without diabetes. In the CABG population, similar rates of all clinical endpoints were observed between the diabetic and nondiabetic group.Conclusions: Diabetes was associated with worse outcome in patients underwent the second-genaration DES implantation for the treatment of unprotected LMCA disease. However, its negative prognostic impact was not found among patients undergoing CABG.