Otsuka Y, Miyazaki S, Okumura H, Yasuda S, Daikoku S, Morii I, Sutani Y, Goto Y, Nonogi H
Division of Cardiology, Department of Internal Medicine, National Cardiovascular Centre, Suita, Osaka, Japan.
Eur Heart J. 2000 Nov;21(21):1790-6. doi: 10.1053/euhj.2000.2181.
We sought to find out what factors are important for long-term prognosis, the small vessel itself or abnormal glucose tolerance, in patients treated with coronary angioplasty.
Patients with coronary artery disease with diabetes mellitus often show diffuse and small coronary artery narrowing. Impaired glucose tolerance has also been reported to be a risk factor for cardiovascular disease.
Among 584 patients who underwent first elective balloon coronary angioplasty, diabetes mellitus and impaired glucose tolerance were present in 197 patients. Large and small vessels were defined by reference vessel diameter before coronary angioplasty as either larger or smaller than 2.5 mm. Patients were categorized into the following four groups: 175 patients with normal glucose tolerance and reference diameter <2.5 mm (group SN), 212 patients with normal glucose tolerance and reference diameter greater than or = 2.5 mm (group LN), 101 patients with abnormal glucose tolerance and reference diameter <2.5 mm (group SD), and 96 patients with abnormal glucose tolerance and reference diameter greater than or = 2.5 mm (Group LD). The cardiac events were compared for a period of 8 years after coronary angioplasty among the four groups.
There was no difference in the percentage diameter stenosis immediately after coronary angioplasty among the four groups. However, group SD showed unfavourable prognosis despite similar minimal lumen diameter after coronary angioplasty compared with group SN. Event-free survival curve of group LD showed a sudden drop approximately 5 years after the coronary angioplasty. In multivariate analysis, the cardiac events were associated with the presence or absence of abnormal glucose tolerance. Furthermore, patients with bad glycaemic control (HbA1c>6.0%) at index coronary angioplasty showed worse event free survival than those with good glycaemic control.
An important determinant for long-term prognosis after coronary angioplasty is a presence of abnormal glucose tolerance per se and not small vessel diameter.
我们试图找出在接受冠状动脉血管成形术的患者中，对于长期预后而言哪些因素更为重要，是小血管本身还是糖耐量异常。
患有糖尿病的冠心病患者常表现出弥漫性的小冠状动脉狭窄。据报道，糖耐量受损也是心血管疾病的一个危险因素。
在584例行首次择期球囊冠状动脉血管成形术的患者中，197例患有糖尿病和糖耐量受损。根据冠状动脉血管成形术前参考血管直径大于或小于2.5 mm来界定大血管和小血管。患者被分为以下四组：175例糖耐量正常且参考直径<2.5 mm的患者（SN组），212例糖耐量正常且参考直径≥2.5 mm的患者（LN组），101例糖耐量异常且参考直径<2.5 mm的患者（SD组），以及96例糖耐量异常且参考直径≥2.5 mm的患者（LD组）。比较四组患者冠状动脉血管成形术后8年的心脏事件。
四组患者冠状动脉血管成形术后即刻的直径狭窄百分比无差异。然而，与SN组相比，SD组尽管冠状动脉血管成形术后最小管腔直径相似，但预后较差。LD组的无事件生存曲线在冠状动脉血管成形术后约5年出现突然下降。在多变量分析中，心脏事件与糖耐量异常的有无相关。此外，在首次冠状动脉血管成形术时血糖控制不佳（糖化血红蛋白>6.0%）的患者比血糖控制良好的患者无事件生存情况更差。
冠状动脉血管成形术后长期预后的一个重要决定因素是糖耐量异常本身，而非小血管直径。
