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目的:比较药物洗脱支架(DES)植入术及冠状动脉旁路移植术(CABG)治疗冠心病多支病变伴糖尿病患者的近期及远期临床疗效。方法:回顾性分析2014年1月~2016年10月在哈尔滨医科大学附属第一医院经冠状动脉造影证实为多支血管病变并伴有糖尿病的患者186例,根据血运重建方式的不同分为DES组及CABG组,随访50.5±14.3个月,观察两组患者住院期间及随访期主要不良心脑血管事件(包括非致死心肌梗死、脑卒中、再次血运重建、全因死亡)的发生情况。结果:在所有入选患者中,DES组有更多双支病变(P<0.05),CABG组三支病变较多(P<0.05),两组在完全血运重建方面无显著性差异(P>0.05)。住院期间,CABG组死亡2例(2.3%),DES组死亡1例(1.0%),死亡率比较无统计学意义(P>0.05)。两组均未出现非致死性心肌梗死、脑卒中、再次血运重建。出院后对186例入选患者随访,其中失访11例(DES组5例,CABG组6例)。随访期间CABG组发生非致死性心肌梗死1例(1.3%)、脑卒中6例(7.5%)、全因死亡10例(12.5%),DES组发生非致死性心肌梗死5例(5.3%)、脑卒中3例(3.2%)、全因死亡9例(9.5%),两组间比较差异无统计学意义(P>0.05);而CABG组再次血运重建2例(2.5%),DES组15例(15.8%),两组比较差异具有统计学意义(P<0.01)。结论:行DES置入术或CABG术治疗冠心病多支病变伴糖尿病患者,住院期间主要心脑血管不良事件发生率、远期非致死性心肌梗死、脑卒中、全因死亡发生情况均无显著性差异,但DES组再次血运重建率明显升高,可能与糖尿病患者较高的再狭窄率有关。
Objective: To compare the short-term and long-term clinical outcomes of drug-eluting stent (DES) implantation and coronary artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and multivessel diabetes. Methods: A retrospective analysis of 186 patients with multivessel disease and diabetes mellitus confirmed by coronary angiography at the First Affiliated Hospital of Harbin Medical University from January 2014 to October 2016 was retrospectively analyzed. According to the different ways of revascularization DES group and CABG group were followed up for 50.5 ± 14.3 months. The incidence of major adverse cardiovascular events (including non-fatal myocardial infarction, stroke, revascularization, all-cause death) during hospitalization and follow-up were observed in both groups . Results: In all patients, there were more double-vessel lesions in DES group (P <0.05), three lesions in CABG group (P <0.05), and no significant difference between the two groups in complete revascularization (P> 0.05). During hospitalization, there were 2 deaths (2.3%) in CABG group and 1 death (1.0%) in DES group, with no significant difference in mortality (P> 0.05). No non-fatal myocardial infarction, stroke, and revascularization occurred in either group. After discharge, 186 patients were selected for follow-up, of whom 11 were lost to follow-up (DES in 5 and CABG in 6). One case (1.3%) of non-fatal myocardial infarction occurred in CABG group, 6 cases (7.5%) of stroke and 10 all-cause death (12.5%) in CABG group and 5 cases (5.3%) of non-fatal myocardial infarction in DES group , Stroke in 3 cases (3.2%), and all-cause death in 9 cases (9.5%). There was no significant difference between the two groups (P> 0.05) 15 cases (15.8%), the difference between the two groups was statistically significant (P <0.01). Conclusions: The incidence of major cardiovascular and cerebrovascular adverse events, long-term non-fatal myocardial infarction, stroke, and all-cause mortality during hospitalization in DES or CABG for the treatment of DM patients with diabetes mellitus is not significant However, the rate of revascularization was significantly higher in DES group, which may be related to the higher restenosis rate in DM patients.