冠心病合并糖尿病患者可降解涂层雷帕霉素洗脱支架置入术后5年随访研究

目的探讨冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入EXCEL可降解涂层雷帕霉素洗脱支架（SES）治疗的远期疗效。方法回顾性随机入选2007年1月至2007年12月住院期间冠心病合并糖尿病患者行PCI162例，并入选同时期150例无糖尿病的冠心病患者行PCI为对照组。随访5年，随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果两组支架术成功率均为100％。随访率100％，随访5年，糖尿病组与非糖尿病组术后并发症发生率（8．8％、7．0％）、卒中发生率（3．9％、3．0％）、心源性死亡率（0．0％、0．0％）差异无统计学意义（均为P〉0．05）。再次血运重建率（30．4％、14．0％）、心绞痛复发率（42，1％、30．0％）、全因死亡率（9．8％、2．0％）糖尿病组高于非糖尿病组；但心源性病死率均为0．0％。结论选择性冠脉内置入药物洗脱支架安全，成功率高，远期疗效尚好，但糖尿病仍是远期不良预后的独立预测因素。

The application of biodegradable polymer sirolimus-eluting stent in patients with coronary heart disease and diabetes mellitus:A five-year follow up study

Objective To assess the long-term outcomes in patients with coronary artery disease（CHD） and diabetes mellitus after the application of percutaneous coronary intervention （PCI） with biodegradable polymer sirolimus-eluting stent. Method 162 CHD patients with diabetes mellitus aged 45-83 years treated with PCI were i- dentified at the time of hospitalization from Jan to Dec ,2007. 150 CHD patients with non-diabetic mellitus aged 43-86 years were recruited at the same time as control. Drug-eluting stents were successfully implanted at target lesions. The major adverse cardiovascular events of were recurrence of angina, death, myocardial infarction, stroke and target lesion revascularization. Clinical follow-up was performed to 5 years after enrollment. Results The procedural success rate and the follow up completion was 100% in both goups. After 5 years follow-up,there were no significant differences in the incidence of complications （8.8% vs 7.0% ）, stroke （3.92% vs3.0% ） and cardiac mortality （ P 〉 0.05 ） be- tween two groups. The rate of revascularization （ 30.4% vs 14.0% ） , recurrence of angina （ 42,1% vs30.0% ） and and all-cause mortality（9.8% vs2.0% ） were significantly higher in CHD patients with diabetes Mellitus group than that in patients with non-diabete mellitus group respectively （ P 〈 0.05 ）. The rate of cardiac mortality was 0% in both groups. Conclusion The application of sirolimus- eluting stents in CHD patients with diabetes mellitus during PCI is safe and effective with acceptable long term outcomes. Diabetes mellitus is still an independently predictor of prognosis.