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不同再血管化治疗对冠心病伴糖尿病患者临床预后的影响*

樊少博1,李曦铭2,高铭佑1,3,赵茹1,肖建勇1,丛洪良2   

  1. 1. 天津市胸科医院
    2. 天津胸科医院
    3.
  • 收稿日期:2011-09-26 修回日期:2011-11-11 出版日期:2012-06-15 发布日期:2012-06-15
  • 通讯作者: 丛洪良

The effect of different revascularization treatment on clinical outcomes in patients with coronary artery disease and type 2 diabetes

  • Received:2011-09-26 Revised:2011-11-11 Published:2012-06-15 Online:2012-06-15

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摘要： 摘要 目的：探讨冠心病伴糖尿病患者再血管化治疗方案的选择。方法：回顾性收集在我院成功接受再血管化治疗的冠心病合并糖尿病患者456例，根据其再血管化方式分为经皮冠状动脉成形术（PCI）组（n=288）和冠状动脉旁路移植术（CABG）组（n=168）并进行组间比较，依据SYNTAX评分将各组分为高、中、低分亚组进行各亚组组间比较。评价的主要终点为术后12个月主要不良心血管事件（全因死亡、致死／非致死性心肌梗死、致死／非致死性卒中），次要终点为12个月再次血运重建。结果：PCI组和CABG组比较，术后12个月内再发心肌梗死比例PCI组高于CABG组（P=0.014），而二组间总不良事件（P=0.072）、其余主要不良事件（P均>0.05）及再次血运重建（P=0.727）的发生率差异无统计学意义。SYNTAX评分PCI组高分亚组不良事件发生率高于CABG组（P=0.017），而在低分亚组与中分亚组（P均>0.05）中两组间差异无统计学意义。结论：冠心病伴糖尿病患者接受CABG治疗并不优于PCI治疗，但SYNTAX评分高分亚组患者接受CABG治疗可能会有更低的不良事件发生率。

关键词: 冠状动脉疾病, 糖尿病, 2型, 血管成形术, 经腔, 经皮冠状动脉, 冠状动脉旁路移植术, 非体外循环

Abstract: Abstract Objective：The study was performed to discuss the selection of different revascularization treatment in patients with coronary artery disease and type 2 diabetes. Methods：Four hundred and fifty-six patients with coronary artery disease and type 2 diabetes were divided into percutaneous coronary intervention（PCI）（n=288）and coronary artery bypass grafting（CABG）（n=168）group. The primary endpoints were major adverse cardiac events（MACE, including all-cause deaths, myocardial infarction，stroke）within 12 months，and the second endpoint was target vessel revascularization within 12 months. Results：The rate of myocardial re-infarction in PCI group was higher than CABG group（P=0.014）within 12 months. There were no significant differences between two groups in total adverse cardiac events（P=0.072）and other MACE（all P>0.05）,also in target vessel revascularization（P=0.727）within 12 months. High-SYNTAX subgroup of PCI group had more incidence of adverse cardiac events than high-subgroup of CABG（P=0.017）,while there is no difference in low-subgroup and middle-one（all P>0.05）. Conclusions：It could not come to the conclusion that CABG was much better than PCI in patients with coronary artery disease and type 2 diabetes, but it might have lower incidence of adverse cardiac events in High-SYNTAX subgroup which patients accept CABG.

Key words: coronary artery disease diabetes mellitus, type 2 angioplasty, transluminal, percutaneous coronary coronary artery bypass, off-pump prognosis follow-up studies SYNTAX score, 非体外循环