糖尿病患者冠脉血运重建_李为菊.ppt

血运重建方式和死亡率 BARI 2 D Mode of Revascularization and Mortality BARI 2 D 4/22/2008 1:58:36 PM Kaplan-Meier Survival curves for the three treatments are illustrated here. The Medical Therapy Group, shown in black, had diminished survival compared to either Bypass Grafting in red or PCI in blue. Thus, revascularization with either PCI or Bypass grafting provided significantly improved survival, although the overall survival at 17 years of follow up was less than 45% * Kaplan-Meier Survival curves for the three treatments are illustrated here. The Medical Therapy Group, shown in black, had diminished survival compared to either Bypass Grafting in red or PCI in blue. Thus, revascularization with either PCI or Bypass grafting provided significantly improved survival, although the overall survival at 17 years of follow up was less than 45% * 3/28/2008 10:07:03 AM 3/17/2008 1:25:02 PM 4/22/2008 1:58:36 PM Disclosures None Diabetes Mellitus:An Epidemic World Wide Incidence of DM 2000 2.8% (171 Million) 2030 4.4% (366 Million) A 36% Increase! Diabetics Receive 25% of Revascularization Procedures in the US Stone, et al, Am J Card, 2007 Prolong life (mortality benefit) Improve quality of life (symptom benefit) angina CHF arrhythmias avoid procedures/rehospitalization, etc Reasonable costs (societal benefit) Treatment for CAD: Goals of Therapy Duke Database: Adjusted 17-year Survival MED CABG PCI Revascularization -Smith PK et al. Ann Thorac Surg 82; 2006 Influence of Severity and Location of Stenosis on Cardiac Death Over a 7-Year Mean Follow-up in 29,082 Patients Catheterized for CAD at Duke Between 1986–2000 and Treated Without Revascularization Relative Chance of Cardiac Death Number of Patients 0 23 34 37 42 48 50 59 71 76 81 94 98 100 None 3 50% One 50–74% Two or Three 50–74% One 3 75% Two 3 75%; None 3 95% One 3 95% Prox. LAD or 50–74% LM Two 3 75%; At least one 3 95% Two 3 75% with 3 95% LAD or 25–49% LM or three 3 75% and 95% Two 3 75% with either Prox. LAD or