Safley David M, House John A, Rutherford Barry D, Marso Steven P
Division of Cardiology and Biostatistics, Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA.
Diab Vasc Dis Res. 2006 May;3(1):45-51. doi: 10.3132/dvdr.2006.006.
The objectives of this study were to evaluate angiographic and clinical outcomes among patients with diabetes mellitus (DM) who underwent percutaneous coronary intervention (PCI) for a chronic total occlusion (CTO). We compared them with matched patients undergoing PCI of a non-CTO lesion. All patients had documented DM. Matching was performed using a propensity score for CTO. There were 506 patients with DM and CTO who were matched with a non-CTO group. Results showed that angiographic success rates were lower with CTO (75% vs. 93%, p<0.001). In-hospital major adverse cardiac event (MACE - death, urgent bypass surgery, Q-wave myocardial infarction or target vessel revascularisation) rates were equivalent (CTO 3.2% vs. non-CTO 2.6%, p=0.57). Survival was not different five years after revascularisation of CTO (75%) vs. non-CTO (79%) (p=0.20). In addition, when DM patients with CTO were analysed according to angiographic success of PCI, there were no significant differences in either in-hospital (success 1.6% vs. failure 2.4%, p=0.7) or 1-year mortality (success 22.2% vs. failure 26.8%, p=0.3). We conclude that PCI of CTO is safe in patients with DM. Angiographic failure is not associated with an increase in MACE rates or mortality as compared to matched non-CTO patients. However, there is not a measurable improvement in survival in this DM-CTO population.
本研究的目的是评估接受经皮冠状动脉介入治疗（PCI）以开通慢性完全闭塞病变（CTO）的糖尿病（DM）患者的血管造影和临床结局。我们将他们与接受非CTO病变PCI的匹配患者进行比较。所有患者均有DM记录。使用CTO倾向评分进行匹配。有506例DM合并CTO患者与非CTO组进行了匹配。结果显示，CTO患者的血管造影成功率较低（75%对93%，p<0.001）。住院期间主要不良心脏事件（MACE，包括死亡、紧急搭桥手术、Q波心肌梗死或靶血管血运重建）发生率相当（CTO组为3.2%，非CTO组为2.6%，p=0.57）。CTO血运重建术后五年生存率与非CTO患者无差异（CTO组为75%，非CTO组为79%）（p=0.20）。此外，当根据PCI血管造影成功情况分析DM合并CTO患者时，住院期间（成功组为1.6%，失败组为2.4%，p=0.7）或1年死亡率（成功组为22.2%，失败组为26.8%，p=0.3）均无显著差异。我们得出结论，DM患者CTO的PCI治疗是安全的。与匹配的非CTO患者相比，血管造影失败与MACE发生率或死亡率增加无关。然而，在DM-CTO人群中生存率没有可测量的改善。
