Iijima Raisuke, Ndrepepa Gjin, Mehilli Julinda, Markwardt Christina, Bruskina Olga, Pache Jürgen, Ibrahim Maryam, Schömig Albert, Kastrati Adnan
Deutsches Herzzentrum, Technische Universtität, Munich, Germany.
Am Heart J. 2007 Oct;154(4):688-93. doi: 10.1016/j.ahj.2007.06.005.
Diabetes mellitus is associated with an increased risk of restenosis, stent thrombosis, and death after percutaneous coronary interventions. Little is known about the late outcome of patients with diabetes mellitus who receive drug-eluting stents (DES).
This study includes a prospective database of 2557 consecutive patients with coronary artery disease who underwent DES implantation in native coronary arteries in 2 German hospitals. The primary end points of the study were mortality and clinical restenosis (target lesion revascularization). Secondary end points were binary angiographic restenosis, stent thrombosis, and the composite of death or myocardial infarction.
Within a median follow-up period of 2.3 years, stent thrombosis occurred in 14 patients with diabetes versus 17 patients without diabetes: 3-year Kaplan-Meier estimates of stent thrombosis were 2.2% versus 1.0%, with a relative risk of 2.17 (95% CI 1.09-4.33, P = .027). Binary angiographic restenosis was observed in 87 patients with diabetes and 208 patients without diabetes (15.2% vs 13.5%, P = .32). Target lesion revascularization was needed in 93 patients with diabetes and 219 patients without diabetes (12.8% vs 12.0%, P = .56). There were 93 deaths among diabetic patients versus 118 deaths among nondiabetic patients: 3-year Kaplan-Meier estimates of mortality were 17.3% versus 7.8%, with a relative risk of 2.10 (95% CI 1.61-2.74, P < .001). After adjustment in the multivariable analyses, diabetes remained an independent predictor of 3-year mortality with a hazard ratio of 1.63 (95% CI 1.23-2.17, P < .001), but not of angiographic (P = .92) or clinical restenosis (P = .97).
Although DES attenuate diabetes-associated excess risk of restenosis, risk of death and thrombotic complications remains higher in patients with diabetes than in nondiabetic patients in the DES era.
糖尿病与经皮冠状动脉介入治疗后再狭窄、支架血栓形成及死亡风险增加相关。对于接受药物洗脱支架（DES）治疗的糖尿病患者的远期预后知之甚少。
本研究纳入了德国两家医院连续2557例接受冠状动脉DES植入术的冠心病患者的前瞻性数据库。该研究的主要终点为死亡率和临床再狭窄（靶病变血运重建）。次要终点为血管造影二元再狭窄、支架血栓形成以及死亡或心肌梗死的复合终点。
在中位随访期2.3年期间，14例糖尿病患者发生支架血栓形成，非糖尿病患者为17例：3年支架血栓形成的Kaplan-Meier估计值分别为2.2%和1.0%，相对风险为2.17（95%CI 1.09 - 4.33，P = 0.027）。87例糖尿病患者和208例非糖尿病患者观察到血管造影二元再狭窄（15.2%对13.5%，P = 0.32）。93例糖尿病患者和219例非糖尿病患者需要靶病变血运重建（12.8%对12.0%，P = 0.56）。糖尿病患者中有93例死亡，非糖尿病患者中有118例死亡：3年死亡率的Kaplan-Meier估计值分别为17.3%和7.8%，相对风险为2.10（95%CI 1.61 - 2.74，P < 0.001）。多变量分析调整后，糖尿病仍然是3年死亡率的独立预测因素，风险比为1.63（95%CI 1.23 - 2.17，P < 0.001），但不是血管造影再狭窄（P = 0.92）或临床再狭窄（P = 0.97）的预测因素。
尽管DES减轻了糖尿病相关的再狭窄额外风险，但在DES时代，糖尿病患者的死亡风险和血栓并发症风险仍高于非糖尿病患者。
