ST段抬高型急性心肌梗死合并糖尿病患者的直接冠状动脉血管成形术
Primary coronary angioplasty in patients with ST segment elevation acute myocardial infarction and diabetes.
作者信息
Dudek Dariusz, Mielecki Waldemar, Wizimirski Marcin, Rakowski Tomasz, Dziewierz Artur, Sorysz Danuta, Tomala Marek, Zorkun Cafer, Zmudka Krzysztof, Dubiel Jacek S
机构信息
Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University, College of Medicine, Cracow, Poland.
出版信息
Kardiol Pol. 2004 Sep;61(9):232-41; discussion 242.
BACKGROUND
Subjects with diabetes constitute 13-25% of patients with ST segment elevation acute myocardial infarction (STEMI). In spite of the introduction of thrombolytic therapy, patients with STEMI and diabetes continue to have worse prognosis than those without diabetes. Primary percutaneous coronary intervention (PCI) has been shown in recent years to be the most effective therapy in patients with STEMI.
AIM
To compare the outcome of STEMI patients with or without diabetes who underwent primary PCI.
METHODS
The study group consisted of 500 consecutive patients with STEMI. The occurrence of major adverse cardiac events (MACE) which included death, reinfarction or repeated PCI of the target vessel, was analysed peri-operatively and during a six-month follow-up period.Results. Diabetes was diagnosed in 68 (13.6%) patients. The mean time duration from the onset of STEMI symptoms to treatment was similar in patients with or without diabetes (230+/-97 min vs 231+/-139 min, NS). Patients with diabetes were older (61.9+/-8.9 vs 57.9+/-10.8 years, p=0.004), had higher body mass index (29+/-4 vs 27+/-5, p=0.002), more frequent history of coronary artery disease (57.4% vs 37.9%, p=0.002), higher prevalence of arterial hypertension (71.6% vs 56.8%, p=0.02) and more frequently the left anterior descending artery as the infarct-related artery (58.8% vs 42.1%, p=0.01). Immediately after PCI, epicardial and myocardial reperfusion rates were lower in patients with rather than without diabetes (TIMI 3: 84.9% vs 91.3%, p=NS, cTFC: 32+/-26 vs 22+/-16, p<0.0001, and MPG3: 25% vs 41.9% p=0.008). Diabetes increased the risk of MACE during in-hospital period by 2.7 times. The rate of MACE during a six-month follow-up period was almost two times higher in patients with rather than without diabetes (death: 8.8% vs 5.1%, reinfarction: 1.5% vs 1.2%, repeated PCI: 11.8% vs 6.9%).
CONCLUSIONS
Primary PCI-achieved epicardial and myocardial reperfusion rate is lower in STEMI patients with rather than without diabetes. The presence of diabetes almost doubles the risk of MACE during a six-month follow-up.
背景
糖尿病患者占ST段抬高型急性心肌梗死（STEMI）患者的13% - 25%。尽管引入了溶栓治疗，但STEMI合并糖尿病的患者预后仍比无糖尿病患者差。近年来，直接经皮冠状动脉介入治疗（PCI）已被证明是STEMI患者最有效的治疗方法。
目的
比较接受直接PCI的STEMI合并或不合并糖尿病患者的治疗结果。
方法
研究组由500例连续的STEMI患者组成。分析主要不良心脏事件（MACE）的发生情况，包括死亡、再梗死或靶血管再次PCI，观察围手术期及六个月随访期的情况。结果。68例（13.6%）患者被诊断为糖尿病。STEMI症状发作至治疗的平均时间在合并糖尿病和未合并糖尿病患者中相似（230±97分钟对231±139分钟，无统计学差异）。糖尿病患者年龄更大（61.9±8.9岁对57.9±10.8岁，p = 0.004），体重指数更高（29±4对27±5，p = 0.002），冠心病病史更常见（57.4%对37.9%，p = 0.002），动脉高血压患病率更高（71.6%对56.8%，p = 0.02），梗死相关动脉为左前降支的情况更常见（58.8%对42.1%，p = 0.01）。PCI术后即刻，合并糖尿病患者的心外膜和心肌再灌注率低于未合并糖尿病患者（TIMI 3级血流：84.9%对91.3%，无统计学差异，校正的心肌灌注分级（cTFC）：32±26对22±16，p < 0.0001，心肌梗死溶栓试验校正的帧计数（MPG3）：25%对41.9%，p = 0.008）。糖尿病使住院期间发生MACE的风险增加2.7倍。六个月随访期内，合并糖尿病患者发生MACE的比率几乎是未合并糖尿病患者的两倍（死亡：8.8%对5.1%，再梗死：1.5%对1.2%，再次PCI：11.8%对6.9%）。
结论
直接PCI实现的心外膜和心肌再灌注率在STEMI合并糖尿病患者中低于未合并糖尿病患者。糖尿病的存在使六个月随访期间发生MACE的风险几乎增加一倍。
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