Tanigawa Takashi, Ishiwata Sugao, Yamamoto Takanobu, Fujimoto Yoh, Nameki Mizuo, Koizumi Tomomi, Iwase Takashi, Nishiyama Shin-ichiro, Nakanishi Shigemoto, Momomura Shin-ichi
Division of Cardiology, Cardiovascular Center, Toranomon Hospital, Toranomon 2-2-2, Minato-ku, Tokyo 105-8470.
J Cardiol. 2002 Mar;39(3):133-40.
The long-term outcome of patients with diabetes who underwent stent placement has not been assessed comprehensively.
Analysis of angioplasty procedures performed between January 1994 and December 1998 identified 140 diabetics (156 lesions) and 169 non-diabetics (187 lesions) who underwent successful stent placement. Follow-up was completed in 286 patients (93%) with a mean follow-up period of 2.8 +/- 1.3 years. Cardiac death, nonfatal myocardial infarction, coronary artery bypass grafting and repeat percutaneous transluminal coronary angioplasty were considered as adverse cardiac events. The primary clinical endpoint was event-free survival at 1 and 3 years. The primary angiographic endpoint was restenosis rate at follow-up angiography (follow-up rate 75% of 257 lesions).
The diabetics were older (66 +/- 8 vs 62 +/- 11 years, p < 0.0005) with more risk factors such as hypertension (69% vs 57%, p < 0.05) and multivessel disease (69% vs 51%, p < 0.005). Final balloon size was smaller in diabetics than in non-diabetics (3.26 +/- 0.61 vs 3.39 +/- 0.53 mm, p < 0.05). Restenosis rate was significantly higher in diabetics than in non-diabetics (36% vs 24%, p < 0.05), but the target lesion revascularization in diabetics was not statistically different compared with non-diabetics (22% vs 16%). Long-term event-free survival was not significantly different between diabetics and non-diabetics (69.9% vs 74.8% at 1 year, 57.3% vs 66.0% at 3 years).
Diabetics have an increased risk for angiographical restenosis after successful stent placement compared to non-diabetics. However, diabetics who underwent stent placement had a favorable clinical long-term outcome similar to non-diabetics.
尚未对接受支架置入术的糖尿病患者的长期预后进行全面评估。
分析1994年1月至1998年12月期间进行的血管成形术，确定140例糖尿病患者（156处病变）和169例非糖尿病患者（187处病变）成功接受了支架置入术。286例患者（93%）完成随访，平均随访期为2.8±1.3年。心脏死亡、非致命性心肌梗死、冠状动脉旁路移植术和重复经皮腔内冠状动脉成形术被视为不良心脏事件。主要临床终点是1年和3年时的无事件生存率。主要血管造影终点是随访血管造影时的再狭窄率（257处病变的随访率为75%）。
糖尿病患者年龄较大（66±8岁对62±11岁，p<0.0005），有更多危险因素，如高血压（69%对57%，p<0.05）和多支血管病变（69%对51%，p<0.005）。糖尿病患者的最终球囊尺寸小于非糖尿病患者（3.26±0.61对3.39±0.53mm，p<0.05）。糖尿病患者的再狭窄率显著高于非糖尿病患者（36%对24%，p<0.05），但糖尿病患者的靶病变血运重建与非糖尿病患者相比无统计学差异（22%对16%）。糖尿病患者和非糖尿病患者的长期无事件生存率无显著差异（1年时为69.9%对74.8%，3年时为57.3%对66.0%）。
与非糖尿病患者相比，糖尿病患者成功置入支架后血管造影再狭窄风险增加。然而，接受支架置入术的糖尿病患者的临床长期预后与非糖尿病患者相似，较为良好。
