老年糖尿病合并急性冠状动脉综合征患者完全与不完全血运重建的预后分析  

Outcome of complete and incomplete revascularization in elderly DM patients with acute coronary syndrome

作　　者：刘洋 薛斌 陈奇 姬劲锐 韩文杰 贾凯龙 刘恒亮 Liu Yang;Xue Bin;Chen Qi;Ji Jinrui;Han Wenjie;Jia Kailong;Liu Hengliang(Department of Cardiology,Affiliated Zhengzhou People's Hospital of Southern Medical University No.2 School of Clinical Medicine,Zhengzhou 450002,Henan Province,China)

机构地区：[1]南方医科大学第二临床医学院附属郑州人民医院心血管内科,450002

出　　处：《中华老年心脑血管病杂志》2022年第1期38-42,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河南省医学科技攻关计划(LHGJ20191067)。

摘　　要：目的探讨完全及不完全血运重建策略对老年2型糖尿病(T2DM)合并急性冠状动脉综合征(ACS)患者PCI预后的影响。方法回顾性分析2011年1月~2017年10月于南方医科大学第二临床医学院附属郑州人民医院心血管内科接受PCI的多支血管病变的老年ACS合并T2DM患者427例,按照冠状动脉血运重建方式分为完全血运重建(CR)组223例,不完全血运重建(IR)组204例。观察主要终点和主要不良心脑血管事件(MACCE)。结果IR组ST段抬高型心肌梗死、全球急性冠状动脉事件注册评分>140分、B型钠尿肽、肌酸激酶同工酶、高敏肌钙蛋白I、糖化血红蛋白明显高于CR组,差异有统计学意义(P<0.05,P<0.01)。IR组冠状动脉3支病变、合并左主干病变、合并慢性闭塞病变、SYNTAX评分及介入干预左主干比例明显高于CR组,置入支架个数、置入支架总长度和造影剂用量明显低于CR组,差异有统计学意义(P<0.05,P<0.01)。住院期间2组全因死亡、心源性死亡、心肌梗死、再次血运重建、支架内血栓及脑卒中发生率比较,差异无统计学意义(P>0.05)。PCI后36个月CR组全因死亡(7.17%vs 13.24%)、心源性死亡(4.04%vs 9.31%)、心肌梗死(3.59%vs 8.33%)、MACCE(17.04%vs 41.67%)、再次血运重建(2.24%vs 20.10%)、心绞痛复发(8.52%vs 30.39%)及再次住院率(9.42%vs 36.76%)明显低于IR组,差异有统计学意义(P<0.05,P<0.01)。结论老年ACS合并T2DM患者行CR与IR相比,术后主要终点事件及MACCE发生减少。Objective To study the effect of complete and incomplete revascularization on the out-come in type 2 DM patients with acute coronary syndrome(ACS).Methods Four hundred and twenty-seven elderly type 2 DM patients with ACS admitted to our hospital from January 2011 to October 2017 were divided into complete revascularization group(n=223)and incomplete revas-cularization group(n=204).The incidence of major end-points and MACCE in two groups was recorded.Results The incidence of STEMI,global acute coronary artery events registry score>140,serum levels of BNP,creatinine kinase isoenzyme,high sensitivity troponin I and glycosylated hemoglobin were significantly higher in incomplete revascularization group than in complete re-vascularization group(P<0.05,P<0.01).The incidence of 3-coronary artery branch lesions,left main coronary artery lesion,chronic occlusion lesion,intervened left main coronary artery lesion and SYNTAX score were significantly higher while the number of implanted stents was signifi-cantly smaller,the total length of implanted stents was significantly shorter and the used dosage of contrast medium was significantly lower in incomplete revascularization group than in complete revascularization group(P<0.05,P<0.01).No significant difference was detected in incidence of all-cause death,cardiogenic death,myocardial infarction,ischemia-driven revascularization,in-stent thrombosis and cerebral stroke between the two groups during the hospital stay time(P>0.05).The incidence of all-cause death,cardiogenic death,myocardial infarction,MACCE,revas-cularization,recurrent angina pectoris rate and readmission rate were significantly lower in com-plete revascularization group than in incomplete revascularization group after 36 months of PCI(7.17%vs 13.24%,4.04%vs 9.31%,3.59%vs 8.33%,17.04%vs 41.67%,2.24%vs 20.10%,8.52%vs 30.39%,9.42%vs 36.76%,P<0.05,P<0.01).Conclusion The incidence of major end-point events and MACCE is lower in elderly type 2 DM patients with ACS after complete re-vascularization than after incomp

关 键 词：糖尿病 急性冠状动脉综合征 经皮冠状动脉介入治疗 ST段抬高型心肌梗死 肌钙蛋白 心肌血管重建术 

分 类 号：R541.4[医药卫生—心血管疾病] R587.2[医药卫生—内科学]