冠状动脉旁路移植术后2型糖尿病患者接受自身血管或静脉桥介入治疗预后的比较  

Comparison of percutaneous coronary intervention in native arteries versus saphenous vein grafts in type 2 diabetes mellitus Patients with Prior coronary artery bypass graft

作　　者：杨志强 王志坚[1] YANG Zhiqiang;WANG Zhijian(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Disease,100029 Beijing,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心血管内科,100029

出　　处：《心肺血管病杂志》2023年第9期881-886,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:比较冠状动脉旁路移植术(coronary artery bypass graft,CABG)后的2型糖尿病(type 2 diabetes mellitus,T2DM)患者选择自身血管或静脉桥行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)对患者预后的影响,并探讨该类患者发生主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE)的预测因素。方法:筛选了CABG术后需再次行PCI治疗的T2DM患者559例,其中488例患者接受自身血管PCI,71例患者接受静脉桥PCI。比较不同靶血管的选择对预后的影响,并采用多因素Cox回归分析发生MACCE的预测因素。主要研究终点为MACCE。结果:与自身血管PCI组相比,静脉桥PCI组患者慢血流/无复流的发生风险更高(2.8%vs.零,P=0.008)。中位随访40个月发现自身血管PCI组与静脉桥PCI组患者发生MACCE的风险相似(35.2%vs.33.8%,P=0.916),并且两组患者发生其他终点事件,差异无统计学意义。多因素Cox回归分析发现,性别(男性)(HR=0.678,95%CI:0.487~0.970,P=0.033)是既往CABG合并T2DM患者PCI后发生MACCE的保护性因素,而慢性肾脏病(chronic kidney disease,CKD)(HR=1.822,95%CI:1.010~3.282,P=0.046)和主动脉内球囊反搏治疗(HR=6.117,95%CI:2.390~15.660,P<0.001)是该部分患者术后发生MACCE的危险因素。结论:在CABG术后的T2DM患者中,不论选择自身血管或静脉桥PCI,术后长期不良心血管事件发生风险相似,但自身血管PCI患者慢血流/无复流现象发生率低。此外,男性患者长期预后较好,而合并CKD及主动脉内球囊反搏治疗后的患者长期预后较差。Objective:To compare the clinical outcomes between percutaneous coronary intervention(PCI)of native arteries and saphenous vein grafts in type 2 diabetes mellitus(T2DM)patients with prior coronary artery bypass graft(CABG),and exploring the independent predictors of major adverse cardiac and cerebrovascular events(MACCE).Methods:A total of 559 T2DM patients with prior CABG who underwent index PCI of native arteries(n=488)or saphenous vein grafts(n=71)were examined.PCI of different target vessel on prognosis was compared,and Cox proportional hazards regression analysis was conducted to explore the independent predictors associated with MACCEs in T2DM patients with prior CABG undergoing index PCI.The primary endpoint was MACCE.Results:Compared with those undergoing native arteries PCI,patients who undergoing saphenous vein grafts PCI had higher risk of slow-flow/no-reflow phenomenon(2.8%vs.zero,P=0.008).During the follow-up of median 40-month,there was similar risk of MACCE between patients undergoing native arteries PCI and saphenous vein grafts PCI(35.2%vs.33.8%,P=0.916).In addition,there were no significantly difference in other study endpoints.After adjusting for confounding by using Cox regression analysis,female(HR=0.678,95%CI:0.487-0.970,P=0.033)was the protector for MACCE,but chronic kidney disease(CKD)(HR=1.822,95%CI:1.010-3.282,P=0.046)and Intra-aortic balloon pump(IABP)(HR=6.117,95%CI:2.390-15.660,P<0.001)were independent risk factors for MACCE in such patients.Conclusions:This study found that T2DM patients with prior CABG had a comparable risk of long-term adverse cardiovascular events between PCI of native arteries and saphenous vein grafts.However,patients with native arteries PCI had a lower risk of slow-flow/no-reflow.In addition,male will have better long-term outcome,while patients who combined with CKD and treated with IABP might have poor long-term outcome.

关 键 词：冠状动脉旁路移置术 经皮冠状动脉介入治疗 2型糖尿病 自身血管 静脉桥 

分 类 号：R54[医药卫生—心血管疾病]