Kip Kevin E, Alderman Edwin L, Bourassa Martial G, Brooks Maria Mori, Schwartz Leonard, Holmes David R, Califf Robert M, Whitlow Patrick L, Chaitman Bernard R, Detre Katherine M
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa 15261, USA.
Circulation. 2002 Apr 23;105(16):1914-20. doi: 10.1161/01.cir.0000014967.78190.bb.
Data are absent that compare midterm angiographic outcome between patients with and without diabetes after initial percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft surgery (CABG). Importantly, diabetes mellitus may differentially influence long-term survival after PTCA or CABG.
Patients with multivessel coronary disease who were previously enrolled in the Bypass Angiopathy Revascularization Investigation to compare initial PTCA versus CABG (n=1829) and who had a reduction in jeopardized myocardium after initial revascularization and at least 1 angiogram during 5-year follow-up were analyzed (n=897). This included 369 CABG-treated patients (16% with diabetes) and 528 PTCA-treated patients (18% with diabetes). The influence of diabetes on angiographic increase in percentage of jeopardized myocardium after initial revascularization with either PTCA or CABG was investigated. Among PTCA patients, the mean percentage increase in total jeopardized myocardium was significantly greater in those with diabetes than in those without at 1-year protocol-directed angiography (42% versus 24%, P=0.05) and on the first clinically performed (unscheduled) angiogram within 30 months (63% versus 50%, P=0.01) but not at 5-year protocol-directed angiography (34% versus 26%, P=0.33). This excess midterm risk associated with diabetes persisted after statistical adjustment. In contrast, among CABG patients, diabetes was not associated with percentage increase in jeopardized myocardium at any angiographic follow-up interval.
Presence of diabetes differentially influences worsening of jeopardized myocardium after initial PTCA compared with CABG. This differential effect occurs irrespective of whether follow-up angiography is undertaken for clinical or nonclinical purposes.
目前尚无数据比较初次经皮腔内冠状动脉成形术（PTCA）和冠状动脉旁路移植术（CABG）后有糖尿病和无糖尿病患者的中期血管造影结果。重要的是，糖尿病可能对PTCA或CABG后的长期生存产生不同影响。
对先前纳入旁路血管病变血运重建研究以比较初次PTCA与CABG（n = 1829）且初次血运重建后心肌危险区有所减少且在5年随访期间至少有1次血管造影的多支冠状动脉疾病患者进行分析（n = 897）。这包括369例接受CABG治疗的患者（16%患有糖尿病）和528例接受PTCA治疗的患者（18%患有糖尿病）。研究了糖尿病对PTCA或CABG初次血运重建后心肌危险区百分比血管造影增加的影响。在PTCA患者中，糖尿病患者在1年方案指导血管造影时（42%对24%，P = 0.05）以及在30个月内首次临床进行（非计划）血管造影时（63%对50%，P = 0.01）总心肌危险区的平均百分比增加显著高于非糖尿病患者，但在5年方案指导血管造影时（34%对26%，P = 0.33）并非如此。经统计学调整后，与糖尿病相关的这种中期额外风险仍然存在。相比之下，在CABG患者中，在任何血管造影随访间隔中，糖尿病与心肌危险区百分比增加均无关联。
与CABG相比，糖尿病的存在对初次PTCA后心肌危险区恶化有不同影响。无论随访血管造影是用于临床还是非临床目的，这种差异效应都会出现。
