药物洗脱支架置入与冠状动脉旁路移植术治疗糖尿病合并多支病变的近中期疗效分析  

Comparison of drug-eluting stents and coronary artery bypass surgery for the treatment of diabetic patients with multivessel coronary disease

作　　者：黄鹏[1,2] 马长生[3] 乔岩[3] 聂绍平[3] 刘小慧[3] 杜昕[3] 康俊平[3] 吕强[3] 贾长琪[3] 张崟[3] 

机构地区：[1]北京大学民航临床医学院 [2]民航总医院干部科空勤科,北京100123 [3]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国实用内科杂志》2011年第8期622-625,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的比较药物洗脱支架(DES)置入与冠状动脉旁路移植术(CABG)治疗糖尿病合并多支病变患者住院时和12个月的临床效果。方法入选2003年7月至2005年12月北京安贞医院645例糖尿病合并多支病变进行血运重建的患者,比较CABG和置入DES组全因死亡、非致死性心肌梗死(M I)、脑血管事件、再次血运重建以及总的心脑血管不良事件(MACCE)发生率。结果 CABG组更多合并有左主干病变、慢性闭塞病变、C型病变和3支病变,完全血运重建较高(P均<0.001);DES组和CABG组总死亡率(P=0.460)、心脏性死亡和非致死性M I复合终点事件(P=0.076)的发生率差异无统计学意义;DES组MACCE、再次血运重建发生率明显增高(P均<0.001)。结论糖尿病合并多支病变患者12个月时CABG有较低MACCE,与再次血运重建发生率较低有关;DES有较高的再次血运重建发生率,与糖尿病较高的再狭窄率和PC I较低的完全血运重建率有关。Objective Comparing coronary artery bypass grafting （CABG） with drug eluting stents （DES） for the treatment of diabetic patients with muhivessel are relatively scant, this observational study evaluated the clinical outcomes of unseleeted patients treated with CABG or percutaneous coronary intervention （PCI） with DES. Methods We included 645 consecutive diabetic patients who underwent either CABG （ n = 282） or DES （ n = 363 ） in AnZheng hospital from July 2003 to December＂ 2005. The primary clinical end points was mortality, the secondary end points were the occurrence of nonfatal myocardial infarction （ MI ） , eerebrovascular events （CVE） , repeat revascularization and major adverse cardiac eerebrovaseular events （MACCE） at 12 months. Re- suits Patients in the CABG group were older and had a higher percentage of 3 vessels disease, left main lesion, chronic total occlusion and ACC/AHA type C lesion than those in the DES group. But Complete revascularization was achieved more often in the CABG group. At 12 months,the mortality rate was similar in the CABG and DES group （P =0. 460）,but the MACCE rate was lower in the CABG group （P 〈0. 001 ） due to less repeat revascularization with CABG （ P 〈 0. 001 ） and higher in the DES group （ P 〈 0. 001 ） due to lower complete revaseularization offered by PCI. ,higher restenosis rate in diabetic patients with DES o The composite rate of cardiac death and ngnfatal myocardial infarction also had no difference in the two groups （ P = 0. 076）. Conclusion At 12 months in diabetic patients with muhivessel coronary artery disease, CABG was associated with less MACCE primarily due to the lower repeat revaseularization rate comparing with DES, higher repeat revascularization rate related to DES resulted from high restenosis rate in diabetic patients and lower rate of complete revascularization offered by PCI.

关 键 词：糖尿病 多支病变 经皮冠状动脉介入治疗 药物洗脱支架 冠状动脉旁路移植术 

分 类 号：R587.1[医药卫生—内分泌]