冠心病合并2型糖尿病患者冠状动脉内支架术后的远期随访

目的 探讨冠心病合并2型糖尿病(DM)患者冠状动脉异常程度和冠状动脉内支架术后远期疗效.方法 将行冠状动脉内支架术的1172例冠心病患者分为DM组(249例)和非DM组(923例).对两组的冠状动脉病变情况及远期临床疗效进行比较.结果 与非DM组比较,DM组病变数较多(P=0.046),2支(P=0.029)和3支(P=0.013)病变比例较高,弥漫病变(P=0.001)、慢性闭塞性病变(P=0.044)及重度病变(P=0.012)多见.两组临床随访率差异无统计学意义.与非DM组相比,DM组支架内再狭窄(55.96/万比35.51/万)、再次血运重建(76.18/万比51.55/万)和主要不良心血管事件(85.50/万比61.47/万)的人月发病率均明显增高(均P=0.000).COX多因素回归分析显示,2型DM与支架内再狭窄(P=0.000)、再次血管重建(P=0.001)、主要不良心血管事件(P=0.003)密切相关,但与死亡无明显相关.结论 合并2型DM的冠心病患者冠状动脉病变较重.2型DM是支架内再狭窄、再次血管重建和主要不良心血管事件的独立预测因子.

Angiographic characteristics and long term clinical outcomes post coronary stenting in non-dlabetic and type 2 diabetic patients with coronary artery disease

Objective To observe the ang/ographic characteristics and the long-term clinical outcomes following coronary stenting in non-diabetic (non-DM) and type 2 diabetic (DM) patients with coronary artery disease. Methods This cohort study enrolled 1172 consecutive patients with coronary heart disease underwent elective coronary stenting (249 type 2 DM and 923 non-DM). The angiographic characteristics and the long-term clinical follow-up results were compared between non-DM and DM patients. Results The follow-up period was (39.2±6.4) months (6-83 months), follow-up rate was 90.3% in DM and 91.0% in uon-DM group (P＞0.05). Compared with non-diabetic patients, there were significantly higher incidences of 2-veasel (P = 0.029) and 3-vessel (P = 0.013) diseases of coronary artery, severe stenosis lesion(P =0.012), chronic total obstructive lesion(P =0.044) and long lesion(P =0.001), in-stent restenosis (ISR,P =0.000) and revascularization(P =0.000) and MACE(P =0.000) in DM patients. COX multiple factorial analysis showed that DM is independent risk factor for ISR (P = 0.000), revascularization(P =0.001) and MACE(P=0.003). Conclusions CHD patients with type 2 DM are associated with multi- and more severe vessel lesions. Type 2 DM is also an independent risk factor for increased ISR, revascularization and MACE post stenting.