2型糖尿病对冠状动脉左主干病变介入治疗预后的影响  

Impact of Type 2 Diabetes Mellitus on the Prognosis of Interventional Therapy for Left Main Coronary Artery Disease

作　　者：王娟[1] 许浩博 乔树宾[1] 胡奉环[1] 杨伟宪[1] 宋雷[1] 袁建松[1] 管常东 郭超[1] 张敏 崔锦刚[1] 徐波[1] WANG Juan;XU Haobo;QIAO Shubin;HU Fenghuan;YANG Weixian;SONG Lei;YUAN Jiansong;GUAN Changdong;GUO Chao;ZHANG Min;CUI Jingang;XU Bo(Coronary Heart Disease Center,National Center for Cardiovascualr Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China;不详)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病中心,北京市100037 [2]永铭诚道(北京)医学科技股份有限公司

出　　处：《中国循环杂志》2021年第4期340-346,共7页Chinese Circulation Journal

摘　　要：目的:探讨合并2型糖尿病对接受经皮冠状动脉介入治疗(PCI)的冠状动脉左主干病变患者预后的影响。方法:回顾性分析中国医学科学院阜外医院2004年1月至2015年12月接受PCI的冠状动脉左主干病变的患者3960例。根据患者是否合并2型糖尿病分为糖尿病组(1084例)和非糖尿病组(2876)例。收集纳入患者的临床资料、实验室检查、冠状动脉造影及介入操作资料。所有患者在1、6、9个月及1、2、3年时通过门诊或电话随访。主要研究终点为主要不良心血管事件(MACE),包括全因死亡、心肌梗死和血运重建。次要终点包括支架血栓和靶病变失败(TLF),后者包括心原性死亡,靶血管心肌梗死和缺血驱动的靶病变血运重建。采用多因素Cox回归分析探讨2型糖尿病是否影响冠状动脉左主干病变行PCI后的近、远期预后。结果:糖尿病组和非糖尿病组患者中分别有1038例(95.8%)、2766例(96.2%)患者完成了3年随访。(1)MACE:与非糖尿病组比较,糖尿病组MACE发生率偏高[15.32%(159例)vs.14.14%(391例)],但差异无统计学意义(P=0.35);两组全因死亡、心肌梗死、所有的血运重建发生率比较,差异均无统计学意义,虽然血运重建的发生率糖尿病组高于非糖尿病组[10.31%(107例)vs.8.46%(234例)],但差异无统计学意义(P=0.08)。(2)次要终点:与非糖尿病组比较,糖尿病组TLF的发生率差异也无统计学意义[8.29%(86例)vs.7.52%(208例),P=0.43]。糖尿病组靶病变血运重建发生率高于非糖尿病组[4.14%(43例)vs.2.78%(77例),P=0.03],差异有统计学意义。但经过多因素Cox分析后,糖尿病并非靶病变血运重建的独立危险因素(HR=0.94,95%CI:0.48~1.87,P=0.84)。结论:冠状动脉左主干病变合并2型糖尿病患者PCI后随访3年MACE的发生率与非糖尿病患者无明显差异。未发现糖尿病是冠状动脉左主干病变患者PCI后血运重建的独立危险因素。Objectives:To evaluate the impact of diabetes mellites(DM)on prognosis of patients undergoing drug eluting stents implantation for left main(LM)coronary artery disease.Methods:We retrospectively analyze the clinical data from patients who received PCI treatment for LM lesions in Fuwai Hospital from January 2004 to December 2015.Clinical features,laboratory examinations,coronary angiography and interventional operation data of the included patients were analyzed.Patients were divided into DM and non-DM groups.All patients were followed up by outpatient visit or telephone call at 1,6,9 months and 1,2,and 3 years post stenting.The main endpoint of the study was major adverse cardiovascular events(MACE,including all-cause death,myocardial infarction,and all revascularization).Secondary endpoints included stent thrombosis and target lesion failure(TLF),including cardiogenic death,target vascular myocardial infarction,and ischemia-driven target lesion revascularization.Multivariate Cox regression analysis was used to investigate whether DM affects the short-and long-term prognosis after stenting for LM.Results:A total of 1038(95,8%)and 2766(96.2%)patients completed 3-year follow-up in DM and non-DM groups.Incidence of MACE was similar between the DM and non-DM group(15.32%[159/1038]vs.14.14%[391/2766],P=0.35).The incidence of all revascularization tended to be higher in the diabetic group than that in the non-diabetic group(10.31%[107/1038]vs.8.46%[234/2766],P=0.08).Incidence of TLF was similar between two group(8.29%[86/1038]vs.7.52%[208/2766],P=0.43).Incidence of revascularization of target lesions was significantly higher in the DM group than in non-DM group(4.14%[43/1038]vs.2.78%[77/2766],P=0.03).Multivariable analysis showed that DM was not an independent risk factor for revascularization of target lesions.Conclusions:Three-year incidence of MACE is similar between patients with or without DM in this patient cohort.Diabetes is not an independent risk factor for revascularization after PCI in patients with left mai

关 键 词：2型糖尿病 经皮冠状动脉介入治疗 冠状动脉左主干病变 主要不良心血管事件 靶病变失败 

分 类 号：R541.4[医药卫生—心血管疾病]