糖尿病患者多支血管支架术后远期疗效.docVIP

糖尿病患者多支血管支架术后远期疗效 　张现朝Δ，丛培玲ΔΔ，孙晓斐ΔΔ，任长杰，武宗寅，王海明 关键词：冠状动脉疾病 【摘要】 目的 评价糖尿病患者行多支血管支架术的临床结果。方法 选择460例连续病人共1092支冠脉病变实行了支架术。根据有无DM将病人分为2组：非糖尿病组（333例／800个病变）、糖尿病组（127例／292个病变）。随访时间为1年。结果 糖尿病组与非糖尿病组支架手术成功率相似（97.6% vs 97.9%，P=0719），糖尿病组植入小支架较多（33.1% vs 17.4%，P=0.07）。临床随访率为97%。与非糖尿病组相比，糖尿病组有较高的1年TLR率（24.8% vs 14.9%，P=0.007）和心脏事件（心源性死亡、心肌梗死和TLR）发生率（38.9% vs 18.3%，P=0.001））； 1年生存率， 糖尿病组低于非糖尿病组（93.4% vs 98.7%，P=0.001)。多变量分析，糖尿病是预测多支病变支架术后1年死亡、心肌梗死、靶病变血运重建的独立危险因素。结论 多支血管支架术手术成功率高，但糖尿病患者有较高的重复血运重建率，较低1年生存率。 【关键词】 冠状动脉疾病；支架；糖尿病；预后 The long term outcomes in diabetic patients after multivessel stenting 【Abstract】 Objective The present study evaluated clinical outcomes in diabetic patients after multivessel stenting. Methods Multivessel stenting was performed in 460patients with 1，092 native coronary lesions. Patients were classified into two groups： no DM (333 patients/800 lesions)； DM (127 patients/292 lesions).The one-year follow-up outcomes was compared.Results Procedural success rate was similar(97.6% vs 97.9%，P=1.000).The number of little stents implanted in diabetic patients were higher than in non-diabetic(33.1% vs 17.4%，P=0.07) .Follow-up rate was 97%.Compared with non-diabetic patients，diabetic patients had higher one-year target lesion revascularization rates(TLR) (24.8% vs 14.9%，P=0.007)and higher occurrence rates of one-year major adverse events(cardic death ，AMIand TLR) （38.9% vs 18.3%，P=0.001）； Lower one-year survival was observed in diabetic patients than in non-diabetic patients (93.4%vs 98.7% ，P=0.001). On multivariable analysis， DM was an independent predictor of one-year mortality， myocardial infarction， and target lesion revascularization after multivessel stenting. Conclusion Despite a high technical success rate of multivessel stenting， diabetic patients have higher subsequent revascularization rates and lower one-year survival than non-diabetic patients. 【Key words】 coronaryarterydisease；stent；diabetesmellitus；prognosis 近年来糖尿病发病率逐年增高，其冠状动脉粥样硬化以