Elsässer Albrecht, Möllmann Helge, Nef Holger M, Hamm Christian W
Kerckhoff-Klinik Bad Nauheim, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
Clin Res Cardiol. 2006 Apr;95(4):195-203. doi: 10.1007/s00392-006-0365-z. Epub 2006 Feb 27.
The diabetic patient is at high risk for coronary artery disease. Incidence as well as severity of the disease is highly increased in comparison to non-diabetic patients. The revascularization of the diabetic patient is a great challenge, since the longterm results are disappointing when compared to non-diabetic patients. The success of coronary artery bypass grafting is limited by increased perioperative mortality and a faster occlusion of especially venous bypass grafts. In percutaneous interventions the excessive high restenosis rates worsen longterm results. Several clinical trials investigated the outcome of the two revascularization strategies and could demonstrate at least a tendency towards better results when the operative approach was chosen. Particularly, the BARI trial showed reduced mortality for surgery when compared to percutaneous coronary interventions. However, in this trial, in 87% of patients undergoing bypass surgery all stenoses were successfully treated, whereas in patients undergoing percutaneous coronary intervention only 76% of all stenoses were primarily successfully treated. In addition, no stents were used in this trial.Furthermore, the enrollment of the previous trials dates one decade ago. These trials do therefore not necessarily represent the current standard therapy, especially for percutaneous coronary interventions. The restenosis rate could be decreased in recent years by means of drug-eluting stents and an aggressive antiplatelet therapy from more than 50% to less than 10% leading to considerably improved long-term results. Therefore, percutaneous coronary interventions have developed to be a reasonable alternative to bypass surgery. Different clinical trials are currently underway (BARI 2D, CarDIA, FREEDOM) comparing the outcome of the two approaches.
糖尿病患者患冠状动脉疾病的风险很高。与非糖尿病患者相比，该疾病的发病率和严重程度都显著增加。糖尿病患者的血运重建是一项巨大挑战，因为与非糖尿病患者相比，其长期结果令人失望。冠状动脉搭桥术的成功率受到围手术期死亡率增加以及尤其是静脉搭桥移植血管更快闭塞的限制。在经皮介入治疗中，过高的再狭窄率会使长期结果恶化。多项临床试验研究了这两种血运重建策略的结果，并且能够证明，选择手术方法时至少有取得更好结果的趋势。特别是，BARI试验显示，与经皮冠状动脉介入治疗相比，手术的死亡率更低。然而，在该试验中，接受搭桥手术的患者中有87%的所有狭窄病变均得到成功治疗，而接受经皮冠状动脉介入治疗的患者中，所有狭窄病变仅有76%最初得到成功治疗。此外，该试验未使用支架。此外，之前那些试验的入组时间是在十年前。因此，这些试验不一定代表当前的标准治疗方法，尤其是对于经皮冠状动脉介入治疗而言。近年来，通过药物洗脱支架和积极的抗血小板治疗，再狭窄率已从50%以上降至不到10%，从而使长期结果得到显著改善。因此，经皮冠状动脉介入治疗已发展成为搭桥手术的一种合理替代方案。目前正在进行不同的临床试验（BARI 2D、CarDIA、FREEDOM），比较这两种方法的结果。
