冠状动脉介入改善冠状动脉慢性闭塞病变合并糖尿病患者的预后研究  

Successful percutaneous coronary intervention improves the clinical prognosis in chronic total occlusion patients with diabetes

作　　者：张骞[1] 闫云峰[1] 罗太阳[1] 宋光远 ZHANG Qian;YAN Yunfeng;LUO Taiyang;SONG Guangyuan(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Diseases,Beijing 100029,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、国家心血管疾病临床医学研究中心、心内科,100029

出　　处：《心肺血管病杂志》2024年第7期680-687,共8页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨PCI治疗能否改善合并糖尿病的冠状动脉慢性闭塞病变(chronic coronary total occlusion,CTO)患者的临床预后。方法:回顾性选取1044例合并1支CTO病变的糖尿病患者,根据PCI是否成功分为成功CTO-PCI组(CTO-S-PCI组)和失败CTO-PCI组(CTO-F-PCI组),观察两组患者随访12个月主要心血管不良事件(major adverse cardiovascular events,MACE)复合终点,包括心源性死亡、靶血管非计划性血运重建(target vessel revascularization,TVR)和非致死性心肌梗死,以及次要终点全因死亡和非计划性血运重建。中位随访时间为43(24,80)个月。结果:本研究共纳入1044例患者,其中CTO-S-PCI组683例(65.4%),CTO-F-PCI组361例(34.6%)。在主要终点MACE:CTO-S-PCI优于CTO-F-PCI[未校正HR:1.422,95%CI:1.100~1.838;校正HR(模型1):1.332,95%CI:1.004~1.767;校正HR(模型2):1.321,95%CI:0.993~1.759];该优势在心源性死亡、TVR方面的趋势是一致的,但非致死性心肌梗死方面两组间无差别。次要终点方面CTO-S-PCI组全因死亡较CTO-F-PCI组显著减低[未校正HR:1.741,95%CI:1.111~2.729;校正HR(模型1):1.674,95%CI:0.969~2.891;校正HR(模型2):1.633,95%CI:0.941~2.838],但非计划性血运重建方面两组间无差别。结论:PCI治疗能够降低CTO合并糖尿病患者心源性死亡、TVR及全因死亡的风险,使糖尿病的CTO患者从PCI治疗策略中获益。Objective:To explore whether patients withchronic coronary total occlusion(CTO)and diabetes could benefit from PCI.Methods:This was a single center,retrospective,cohort study.A total of 1044 consecutive CTO patients with diabetes who underwent diagnostic coronary angiography were enrolled.According to whether PCI was successful,the enrolled patients were divided into successful CTO-PCI group and failed CTO-PCI group.Major adverse cardiovascular events,including cardiac death,target vessel revascularization,nonfatal infarction,and secondary end point,including all-cause mortality and revascularization,were assessed during 12 months follow-up.The median follow-up was 43 months(24-80 months).Results:Of the 1044 patients who were enrolled in the study,683 were assigned to the successful CTO-PCI group and 361 to the failed CTO-PCI group.The rate of MACE was 20.8%in the successful CTO-PCI group as compared with 27.4%in the failed CTO-PCI group[unadjusted hazard ratio HR=1.422,95%CI:1.100-1.838;adjusted HR(model 1)1.332;95%CI:1.004-1.767;adjusted HR(model 2)1.321,95%CI:0.993-1.759],which b enefited from cardiac death and target vessel revascularization.The rate of all-cause mortality was also lower in the successful CTO-PCI group[unadjusted HR=.741,95%CI:1.111-2.729;adjusted HR(model 1)1.674,95%CI:0.969-2.891;adjusted HR(model 2)1.633,95%CI:0.941-2.838].The rate of nonfatal infarction and revascularization was not significant between the two groups.Conclusions:Among patients with CTO and diabetes,successful PCI resulted in a lower rate of cardiac death,target vessel revascularization and all-cause mortality within 12 months follow-up than failed PCI.

关 键 词：经皮冠状动脉介入 冠状动脉慢性闭塞病变 糖尿病 

分 类 号：R54[医药卫生—心血管疾病]