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目的比较药物洗脱支架(DES)置入与冠状动脉旁路移植术(CABG)治疗糖尿病合并多支病变患者住院时和12个月的临床效果。方法入选2003年7月至2005年12月北京安贞医院645例糖尿病合并多支病变进行血运重建的患者,比较CABG和置入DES组全因死亡、非致死性心肌梗死(M I)、脑血管事件、再次血运重建以及总的心脑血管不良事件(MACCE)发生率。结果 CABG组更多合并有左主干病变、慢性闭塞病变、C型病变和3支病变,完全血运重建较高(P均<0.001);DES组和CABG组总死亡率(P=0.460)、心脏性死亡和非致死性M I复合终点事件(P=0.076)的发生率差异无统计学意义;DES组MACCE、再次血运重建发生率明显增高(P均<0.001)。结论糖尿病合并多支病变患者12个月时CABG有较低MACCE,与再次血运重建发生率较低有关;DES有较高的再次血运重建发生率,与糖尿病较高的再狭窄率和PC I较低的完全血运重建率有关。
Objective To compare the clinical effects of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) on hospitalization and 12-month survival in patients with diabetic multi-vessel disease. Methods A total of 645 patients with diabetes mellitus complicated with multiple lesions undergoing revascularization in Beijing Anzhen Hospital from July 2003 to December 2005 were enrolled in this study. CABG and DES were compared between all-cause, non-fatal myocardial infarction (MI) Vascular events, revascularization, and total cardiovascular and cerebrovascular adverse events (MACCE). Results The CABG group had more left main trunk lesions, chronic occlusive lesions, C-type lesions and 3 lesions with a higher complete revascularization (P <0.001). The total mortality in the DES and CABG groups was significantly lower than that in the CABG group (P = 0.460) There was no significant difference in the incidence of cardiac death and non-fatal MI composite end point (P = 0.076). The incidence of MACCE and revascularization in DES group was significantly higher (all P <0.001). Conclusions CABG at 12 months in diabetic patients with multivessel disease has a lower MACCE, which is associated with a lower incidence of revascularization. DES has a higher incidence of revascularization and is associated with a higher rate of restenosis and PC I lower the rate of complete revascularization.