Cole Jason H, Jones Ellis L, Craver Joseph M, Guyton Robert A, Morris Douglas C, Douglas John S, Ghazzal Ziyad, Weintraub William S
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
J Am Coll Cardiol. 2002 Dec 4;40(11):1968-75. doi: 10.1016/s0735-1097(02)02561-5.
This study evaluated both short- and long-term outcomes of diabetic patients who underwent repeat coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) after initial CABG.
Although diabetic patients who have multivessel coronary disease and require initial revascularization may benefit from CABG as compared with PCI, the uncertainty concerning the choice of revascularization may be greater for diabetic patients who have had previous CABG.
Data were obtained over 15 years for diabetic patients undergoing PCI procedures or repeat CABG after previous coronary surgery. Baseline characteristics were compared between groups, and in-hospital, 5-year, and 10-year mortality rates were calculated. Multivariate correlates of in-hospital and long-term mortality were determined.
Both PCI (n = 1,123) and CABG (n = 598) patients were similar in age, gender, years of diabetes, and insulin dependence, but they varied in presence of hypertension, prior myocardial infarction, angina severity, heart failure, ejection fraction, and left main disease. In-hospital mortality was greater for CABG, but differences in long-term mortality were not significant (10 year mortality, 68% PCI vs. 74% CABG, p = 0.14). Multivariate correlates of long-term mortality were older age, hypertension, low ejection fraction, and an interaction between heart failure and choice of PCI. The PCI itself did not correlate with mortality.
The increased initial risk of redo CABG in diabetic patients and the comparable high long-term mortality regardless of type of intervention suggest that, except for patients with severe heart failure, PCI be strongly considered in all patients for whom there is a percutaneous alternative.
本研究评估了初次冠状动脉搭桥术（CABG）后接受再次冠状动脉搭桥术或经皮冠状动脉介入治疗（PCI）的糖尿病患者的短期和长期预后。
尽管患有多支冠状动脉疾病且需要初次血运重建的糖尿病患者与PCI相比可能从CABG中获益，但对于既往接受过CABG的糖尿病患者，血运重建选择的不确定性可能更大。
收集了15年间接受PCI手术或既往冠状动脉手术后再次CABG的糖尿病患者的数据。比较了各组的基线特征，并计算了住院、5年和10年死亡率。确定了住院和长期死亡率的多变量相关因素。
PCI组（n = 1123）和CABG组（n = 598）患者在年龄、性别、糖尿病病程和胰岛素依赖方面相似，但在高血压、既往心肌梗死、心绞痛严重程度、心力衰竭、射血分数和左主干病变方面存在差异。CABG组的住院死亡率更高，但长期死亡率差异不显著（10年死亡率，PCI组为68%，CABG组为74%，p = 0.14）。长期死亡率的多变量相关因素为年龄较大、高血压、射血分数低以及心力衰竭与PCI选择之间的相互作用。PCI本身与死亡率无关。
糖尿病患者再次CABG的初始风险增加，且无论干预类型如何，长期死亡率都相当高，这表明，除了严重心力衰竭患者外，对于所有有经皮替代方案的患者，都应强烈考虑PCI。
