Rozenman Y, Sapoznikov D, Gotsman M S
Cardiology Department, Hadassah University Hospital, Jerusalem, Israel.
Clin Cardiol. 2000 Dec;23(12):890-4. doi: 10.1002/clc.4960231207.
Patients with diabetes mellitus (D) (both insulin-requiring D [IRD] and non-IRD) who undergo angioplasty have worse long-term outcome than do non-D patients. Few data are available in the literature that explain these findings.
The study was undertaken to compare restenosis and progression of coronary disease after angioplasty in IRD patients, in non-IRD patients, and in non-D patients.
Diabetic patients who underwent coronary angioplasty were separated into two subgroups: IRD and non-IRD patients. Their angiographic outcome was compared with non-D patients. We examined retrospectively 353 coronary angiograms of patients who were referred for diagnostic angiography > 1 month after successful angioplasty. Quantitative angiography was used to determine the outcome in dilated narrowings (restenosis) and in nondilated narrowings (disease progression).
Baseline clinical and angiographic characteristics were similar in all groups. Restenosis rate was higher in IRD (61%) than in non-IRD (36%) and non-D (35%) patients (p = 0.04). Late luminal loss after angioplasty was two times greater in IRD patients than in the other two groups (p = 0.01). Disease progression of nondilated narrowings was significantly more prominent in non-IRD than in non-D patients: Diameter stenoses were similar in the initial angiogram, but narrowings were significantly more severe (p = 0.02) in the final angiogram (70 +/- 27% and 60 +/- 33%, respectively). New narrowings were more common in non-IRD than in non-D patients: there was a 23% increase in the number of narrowings in the follow-up angiogram in non-IRD patients compared with only 12% in non-D patients (p < 0.003). These new narrowings were more common (p = 0.01) in angioplasty arteries (57 narrowings on 420 arteries--13.6%) than in nonangioplasty arteries (54 narrowings on 639 arteries--8.5%).
Restenosis is more common in IRD patients and explains the high rate of adverse cardiac events within the first year after coronary intervention in these patients (mainly target lesion revascularization). Disease progression (including new narrowings) is the main determinant of patient outcome > 1 year after coronary intervention and is accelerated in non-IRD compared with non-D patients.
接受血管成形术的糖尿病患者（包括需胰岛素治疗的糖尿病患者[IRD]和非IRD患者）的长期预后比非糖尿病患者差。文献中几乎没有数据能解释这些发现。
本研究旨在比较IRD患者、非IRD患者和非糖尿病患者血管成形术后的再狭窄情况及冠状动脉病变进展。
接受冠状动脉血管成形术的糖尿病患者被分为两个亚组：IRD患者和非IRD患者。将他们的血管造影结果与非糖尿病患者进行比较。我们回顾性分析了353例在成功血管成形术1个月后因诊断性血管造影而接受检查的患者的冠状动脉造影。采用定量血管造影来确定扩张狭窄处（再狭窄）和未扩张狭窄处（病变进展）的结果。
所有组的基线临床和血管造影特征相似。IRD患者的再狭窄率（61%）高于非IRD患者（36%）和非糖尿病患者（35%）（p = 0.04）。血管成形术后IRD患者的晚期管腔丢失比其他两组大两倍（p = 0.01）。非扩张狭窄处的病变进展在非IRD患者中比非糖尿病患者更显著：初始血管造影时直径狭窄相似，但最终血管造影时狭窄更严重（p = 0.02）（分别为70±27%和60±33%）。新狭窄在非IRD患者中比非糖尿病患者更常见：与非糖尿病患者随访血管造影中狭窄数量仅增加12%相比，非IRD患者随访血管造影中狭窄数量增加了23%（p < 0.003）。这些新狭窄在血管成形术血管中更常见（p = 0.01）（420条血管中有57处狭窄——13.6%），而非血管成形术血管中较少见（639条血管中有54处狭窄——8.5%）。
再狭窄在IRD患者中更常见，这解释了这些患者在冠状动脉介入治疗后第一年内不良心脏事件发生率高的原因（主要是靶病变血管重建）。病变进展（包括新狭窄）是冠状动脉介入治疗1年后患者预后的主要决定因素，与非糖尿病患者相比，非IRD患者的病变进展加速。
