糖尿病多支冠状动脉病变患者不同血管重建疗效的比较  

Evaluation of different revascularization strategies in diabetic patients with multivessel abnormalities

作　　者：黎旭[1] 刘晓惠[1] 聂绍平[1] 杜昕[1] 吕强[1] 康俊平[1] 董建增[1] 顾承雄[2] 黄方炯[2] 周玉杰[1] 陈方[1] 吕树铮[1] 吴学思[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]首都医科大学附属北京安贞医院心外科,北京100029

出　　处：《临床心血管病杂志》2007年第7期519-522,共4页Journal of Clinical Cardiology

基　　金：国家重点基础研究发展规划基金资助项目(973计划)(2003CB517103)

摘　　要：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。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〈0.0l） times that of the CABGgroup, 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.

关 键 词：糖尿病 冠状动脉疾病 支架 冠状动脉旁路移植术 

分 类 号：R547.1[医药卫生—心血管疾病]