不同年龄糖尿病合并急性冠状动脉综合征患者多支血管病变不完全血运重建的预后分析  

Incomplete revascularizationin patients with diabetes mellitus complicated by multi-vessel disease of acute coronary syndrome in different ages:an analysis on prognosis

作　　者：刘洋[1] 陈奇 姬劲锐 薛斌 吴雷 万冬宇 刘恒亮 Liu Yang;Chen Qi;Ji Jinrui;Xue Bin;Wu Lei;Wan Dongyu;Liu Hengliang(Department of Cardiology,Fifth Clinical Medical School(Zhengzhou People's Hospital),Henan University of Chinese Medicine,Zhengzhou 450002,China;不详)

机构地区：[1]河南中医药大学第五临床医学院(郑州人民医院)心内科,郑州450002

出　　处：《中国循证心血管医学杂志》2024年第9期1060-1064,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省科技攻关计划(172102310309);河南省医学科技攻关计划(LHGJ20191067)。

摘　　要：目的探讨不同年龄糖尿病合并急性冠状动脉综合征(acute coronary syndrome,ACS)冠状动脉多支血管病变(multivessel disease,MVD)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)不完全血运重建(incomplete revascularization,IR)对预后的影响。方法回顾性分析郑州人民医院2011年1月至2019年12月行PCI的ACS冠状动脉MVD合并糖尿病患者IR的连续资料,依据年龄分为三组:A组:非老年组(306例),年龄38~59(52.37±7.44)岁;B组:老年组(204例),年龄60~79(71.89±8.79)岁;C组:高龄老年组(137例),年龄82~94岁(86.87±5.77)。分析36个月主要终点(全因死亡、心源性死亡、心肌梗死)和主要不良心脑血管事件(MACCE,心源性死亡、心肌梗死、再次血运重建、支架内血栓和脑卒中)的发生率。结果C组完全性血运重建(CR)率显著低于B组和A组(40.17%vs.52.22%vs.50.96%,P<0.001)。三组全因死亡(C、B、A组分别为:18.25%vs.10.29%vs.10.46%,P=0.043)、心源性死亡(16.79%vs.9.31%vs.6.86%,P=0.005)、心肌梗死(15.33%vs.8.33%vs.0.65%,P<0.001)有统计学意义。三组主要不良心脑血管事件(major adverse cardiacand cerebrovascular events,MACCE)发生率(56.20%vs.41.67%vs.19.28%,P<0.001)、再次血运重建率(18.98%vs.20.10%vs.8.50%,P<0.001)、心绞痛复发率(24.09%vs.30.39%vs.19.61%,P=0.020)有显著性差异。C组脑卒中的发生率和再次住院率显著高于B组和A组(P<0.05)。结论高龄老年ACS合并糖尿病患者冠状动脉血管病变复杂,选择IR术后MACCE发生率显著高于非老年组和老年组患者。Objective To discuss the influence of incomplete revascularization(IR)on prognosis in patients with diabetes mellitus(DM)complicated by multi-vessel disease of acute coronary syndrome(ACS-MVD)in different ages after percutaneous coronary intervention(PCI).Methods The continuous data of IR was retrospectively analyzed in DM patients complicated by ACS-MVD undergone PCI in Zhengzhou People’s Hospital from Jan.2011 to Dec.2019.The patients were divided,according to age,into group A(n=306,aged from 38 to 59,52.37±7.44),group B(n=204,aged from 60 to 79,71.89±8.79)and group C(n=137,aged from 82 to 94,86.87±5.77).The incidence ratesof 36-month primary endpoint events including all-cause death,cardiac death and myocardial infarction(MI)and major adverse cardiovascular and cerebrovascular events(MACCE)including cardiac death,MI,revascularization,in-stentthrombosis and stroke were analyzed.Results The incidence of complete revascularization(CR)was significantly lower in group C than that in groups B and A(40.17%vs.52.22%vs.50.96%,P<0.001).The differences in all-cause death(18.25%vs.10.29%vs.10.46%,P=0.043),cardiac death(16.79%vs.9.31%vs.6.86%,P=0.005)and MI(15.33%vs.8.33%vs.0.65%,P<0.001)had statisticalsignificance among 3 groups.The differences in MACCE incidence(56.20%vs.41.67%vs.19.28%,P<0.001),CR rate(18.98%vs.20.10%vs.8.50%,P<0.001)and recurrence rate of angina pectoris(24.09%vs.30.39%vs.19.61%,P=0.020)were significant among 3 groups.The incidence of stroke and re-hospitalization rate were higher in group C than those in groups B and A(all P<0.05).Conclusion The coronary artery lesions are complex in very old DM patients complicated by ACS,and MACCE incidence rates are significantly higher in very old patients than those in non-elderly and elderly patientsafter IR surgery.

关 键 词：急性冠状动脉综合征 糖尿病 多支血管病变 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]