Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Diabetes Care. 2010 Sep;33(9):1976-82. doi: 10.2337/dc10-0247. Epub 2010 Jun 2.
To evaluate the association of successive percutaneous coronary intervention (PCI) modalities with balloon angioplasty (BA), bare-metal stent (BMS), drug-eluting stents (DES), and pharmacotherapy over the last 3 decades with outcomes among patients with diabetes in routine clinical practice.
We examined outcomes in 1,846 patients with diabetes undergoing de novo PCI in the multicenter, National Heart, Lung, and Blood Institute-sponsored 1985-1986 Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry and 1997-2006 Dynamic Registry. Multivariable Cox regression models were used to estimate the adjusted risk of events (death/myocardial infarction [MI], repeat revascularization) over 1 year.
Cumulative event rates for postdischarge (31-365 days) death/MI were 8% by BA, 7% by BMS, and 7% by DES use (P = 0.76) and for repeat revascularization were 19, 13, and 9% (P < 0.001), respectively. Multivariable analysis showed a significantly lower risk of repeat revascularization with DES use when compared with the use of BA (hazard ratio [HR] 0.41 [95% CI 0.29-0.58]) and BMS (HR 0.55 [95% CI 0.39-0.76]). After further adjustment for discharge medications, the lower risk for death/MI was not statistically significant for DES when compared with BA.
In patients with diabetes undergoing PCI, the use of DES is associated with a reduced need for repeat revascularization when compared with BA or BMS use. The associated death/MI benefit observed with the DES versus the BA group may well be due to greater use of pharmacotherapy.
评估过去 30 年来连续经皮冠状动脉介入治疗（PCI）方式与球囊血管成形术（BA）、裸金属支架（BMS）、药物洗脱支架（DES）和药物治疗相结合，对糖尿病患者在常规临床实践中的治疗效果的影响。
我们检查了 1846 名在多中心、美国国立心肺血液研究所（National Heart, Lung, and Blood Institute）赞助的 1985-1986 年经皮腔内冠状动脉血管成形术（PTCA）注册研究和 1997-2006 年动态注册研究中接受初次 PCI 的糖尿病患者的治疗结果。多变量 Cox 回归模型用于估计 1 年内的事件（死亡/心肌梗死[MI]，再次血运重建）的调整后风险。
出院后（31-365 天）死亡/MI 的累积事件发生率分别为 BA 组 8%，BMS 组 7%，DES 组 7%（P=0.76），重复血运重建率分别为 19%、13%和 9%（P<0.001）。多变量分析显示，与 BA 相比，DES 的重复血运重建风险显著降低（风险比[HR]0.41[95%CI0.29-0.58]），与 BMS 相比，DES 的重复血运重建风险也显著降低（HR 0.55[95%CI0.39-0.76]）。在进一步调整出院药物治疗后，DES 与 BA 相比，死亡/MI 的风险降低不再具有统计学意义。
在接受 PCI 的糖尿病患者中，与 BA 或 BMS 相比，DES 的使用与减少重复血运重建的需求相关。与 BA 相比，DES 与观察到的死亡/MI 获益可能是由于药物治疗的使用率更高。
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