Hong S J, Kim M H, Ahn T H, Ahn Y K, Bae J H, Shim W J, Ro Y M, Lim D-S
Department of Cardiology, Cardiovascular Center, Korea University Hospital, Seoul, Korea.
Heart. 2006 Aug;92(8):1119-24. doi: 10.1136/hrt.2005.075960. Epub 2006 Jan 31.
To identify parameters influencing the likelihood of restenosis after implantation of drug-eluting stents (DES) in patients with diabetes.
Stented patients (n = 840) with DES were retrospectively reviewed for inclusion in the study from the Multicenter PCI Database Registry. From this database, 211 (25.1%) of 840 patients with six-month angiographic follow up had diabetes. Predictors of coronary restenosis were identified with univariate and multivariate logistic regression analyses.
Restenosis occurred in 92 of 629 (14.6%) patients without diabetes and in 44 (20.9%) of 211 patients with diabetes (p < 0.001). Multivariate parameters for predicting restenosis in the diabetic group were current smoking (odds ratio (OR) 1.923, 95% confidence interval (CI) 1.055 to 4.725, p = 0.036), higher C reactive protein concentration (OR 1.031, 95% CI 1.011 to 1.075, p = 0.043), use of the paclitaxel-eluting stent (OR 2.638, 95% CI 1.338 to 5.200, p = 0.005), longer stent length (OR 1.065, 95% CI 1.021 to 1.119, p = 0.033), smaller reference diameter before DES implantation (OR 0.501, 95% CI 0.110 to 0.965, p = 0.040), smaller reference diameter (OR 0.455, 95% CI 0.120 to 0.814, p = 0.026) and minimum lumen diameter (OR 0.447, 95% CI 0.068 to 0.876, p = 0.039) after DES implantation.
Even with the introduction of DES, diabetes remains a significant predictor of coronary restenosis, especially in cases of a small baseline vessel size, small vessel size after percutaneous coronary intervention, longer stent length, use of the paclitaxel-eluting stent, current smoking and high C reactive protein concentration.
确定影响糖尿病患者药物洗脱支架（DES）植入术后再狭窄可能性的参数。
从多中心经皮冠状动脉介入治疗（PCI）数据库登记处回顾性纳入接受DES植入的患者（n = 840）进行研究。在该数据库中，840例有6个月血管造影随访的患者中有211例（25.1%）患有糖尿病。通过单因素和多因素逻辑回归分析确定冠状动脉再狭窄的预测因素。
629例无糖尿病患者中有92例（14.6%）发生再狭窄，211例糖尿病患者中有44例（20.9%）发生再狭窄（p < 0.001）。糖尿病组预测再狭窄的多因素参数包括当前吸烟（比值比（OR）1.923，95%置信区间（CI）1.055至4.725，p = 0.036）、较高的C反应蛋白浓度（OR 1.031，95%CI 1.011至1.075，p = 0.043）、使用紫杉醇洗脱支架（OR 2.638，95%CI 1.338至5.200，p = 0.005）、较长的支架长度（OR 1.065，95%CI 1.021至1.119，p = 0.033）、DES植入前较小的参考直径（OR 0.501，95%CI 0.110至0.965，p = 0.040）、DES植入后较小的参考直径（OR 0.455，95%CI 0.120至0.814，p = 0.026）和最小管腔直径（OR 0.447，95%CI 0.068至0.876，p = 0.039）。
即使引入了DES，糖尿病仍然是冠状动脉再狭窄的重要预测因素，尤其是在基线血管尺寸较小、经皮冠状动脉介入治疗后血管尺寸较小、支架长度较长、使用紫杉醇洗脱支架、当前吸烟和C反应蛋白浓度较高的情况下。
