Mazeika Peter, Prasad Neeraj, Bui Sanh, Seidelin Peter H
Division of Cardiology, Department of Medicine, The Toronto Hospital, General Division, Toronto, Ontario, Canada.
Am Heart J. 2003 Jun;145(6):1013-21. doi: 10.1016/S0002-8703(03)00085-1.
Patients with diabetes mellitus are particularly prone to restenosis after percutaneous coronary intervention. An exploratory, nested, case-control study was undertaken to identify clinical, lesional, and procedural predictors of angiographic restenosis in these patients.
Seventy-five patients with diabetes mellitus with 86 coronary lesions were selected from a larger population of 217 patients who had undergone 6-month angiographic follow-up after a first, successful balloon angioplasty (PTCA) or stent implantation procedure. Data collection was by patient interview and review of hospital database and other medical records. All angiograms were analyzed with quantitative coronary angiography, and restenosis was defined as a >or=50% diameter reduction at the treated site. A multivariate analysis of 10 prespecified explanatory variables, derived from a literature review, was performed on a per-lesion basis.
There were 45 patients (53 lesions) with restenosis and 30 patients (33 lesions) without restenosis. Univariate predictors of binary restenosis were periprocedural glycosylated hemoglobin level, vessel reference diameter, PTCA, and larger final balloon size to reference artery diameter ratio. Multiple logistic regression identified poor glycemic control (odds ratio [OR] 3.03, 95% CI 1.06-8.65, P =.038), small vessel reference diameter (OR 3.41, 95% CI 1.17-9.95, P =.025), and mode of intervention (OR 3.12, 95% CI 1.08-9.00, P =.036) as independent risk factors. Vessel reference diameter appeared to be an important effect modifier of the association between type of intervention and angiographic outcome, with stenting no longer superior to PTCA in patients with diabetes mellitus who had vessels <2.87 mm in diameter (P =.054).
Poor glycemic control, vessel size, and PTCA were independent predictors of restenosis in patients with diabetes mellitus. It is possible that improved periprocedural glycemic control, in addition to stenting, may reduce the restenosis rate in these patients.
糖尿病患者在经皮冠状动脉介入治疗后特别容易发生再狭窄。开展了一项探索性、巢式病例对照研究，以确定这些患者血管造影再狭窄的临床、病变和手术预测因素。
从217例首次成功进行球囊血管成形术（PTCA）或支架植入术后接受6个月血管造影随访的患者中，选取75例患有糖尿病且有86处冠状动脉病变的患者。通过患者访谈以及查阅医院数据库和其他病历进行数据收集。所有血管造影均采用定量冠状动脉造影分析，再狭窄定义为治疗部位直径缩小≥50%。基于文献综述得出的10个预先设定的解释变量，对每个病变进行多变量分析。
有45例患者（53处病变）发生再狭窄，30例患者（33处病变）未发生再狭窄。二元再狭窄的单变量预测因素为围手术期糖化血红蛋白水平、血管参考直径、PTCA以及最终球囊大小与参考动脉直径之比。多因素logistic回归确定血糖控制不佳（比值比[OR]3.03，95%可信区间1.06 - 8.65，P = 0.038）、血管参考直径小（OR 3.41，95%可信区间1.17 - 9.95，P = 0.025）和干预方式（OR 3.12，95%可信区间1.08 - 9.00，P = 0.036）为独立危险因素。血管参考直径似乎是干预类型与血管造影结果之间关联的重要效应修饰因素，对于直径<2.87 mm的糖尿病患者，支架置入术不再优于PTCA（P = 0.054）。
血糖控制不佳、血管大小和PTCA是糖尿病患者再狭窄的独立预测因素。除了支架置入术外，改善围手术期血糖控制可能会降低这些患者的再狭窄率。
