糖尿病患者多支冠状动脉疾病的经皮冠状动脉介入治疗与冠状动脉旁路移植术对比

PCI versus CABG for multivessel coronary disease in diabetics.

作者信息

Tarantini Giuseppe, Ramondo Angelo, Napodano Massimo, Favaretto Enrico, Gardin Arianna, Bilato Claudio, Nesseris Georghios, Tarzia Vincenzo, Cademartiri Filippo, Gerosa Gino, Iliceto Sabino

机构信息

Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.

出版信息

Catheter Cardiovasc Interv. 2009 Jan 1;73(1):50-8. doi: 10.1002/ccd.21757.

DOI:10.1002/ccd.21757

PMID:19089938

Abstract

OBJECTIVES

To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment.

BACKGROUND

Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES-PCI versus CABG in DM patients with MVD.

METHODS

From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES-PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke.

RESULTS

Compared with PCI patients, CABG patients had higher prevalence of 3-vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2-year follow-up, MACCE were not different between CABG group and DES-PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES-PCI increased the risk of 24-month MACCE in total population (OR 1.8; P = 0.04).

CONCLUSIONS

For patients with DM and MVD, a clinical judgment-based revascularization by DES-PCI is not associated with worse 2-year outcome compared with CABG.

摘要

目的

探讨在临床判断基础上，药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）策略用于多支血管病变（MVD）糖尿病患者的临床疗效，并与冠状动脉旁路移植术（CABG）进行比较。

背景

糖尿病（DM）是PCI术后预后不良的主要危险因素。然而，如果血管重建术（PCI与CABG）的选择基于医生的判断而非随机分组，PCI可能会带来更好的预后。在MVD糖尿病患者中，比较DES-PCI与CABG血管重建术的经验有限。

方法

2004年8月至2005年8月，我院220例连续性MVD糖尿病患者接受了DES-PCI（93例）或CABG（127例）治疗。血管重建术的类型取决于患者和/或医生的选择。主要不良心脑血管事件（MACCE）包括死亡、心肌梗死、再次冠状动脉血管重建术和中风。

结果

与PCI患者相比，CABG患者三支血管病变的患病率更高（P<0.001），左前降支（LAD）明显受累（P<0.001），存在完全闭塞（P=0.04），有侧支循环（P<0.001）。在2年随访时，CABG组和DES-PCI组的MACCE无差异（OR 1.2；P=0.6），仅在倾向分析中排除血管重建术选择的临床判断时，DES-PCI增加了总体人群24个月MACCE的风险（OR 1.8；P=0.04）。