Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
Am J Med. 2011 Mar;124(3):265-75. doi: 10.1016/j.amjmed.2010.09.015.
Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension.
Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all "first percutaneous coronary interventions" between January 1, 2006, and December 31, 2008 (n=44,268; followed an average of 1.9 [± 0.9] years).
Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes.
After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.
与糖尿病或高血压相关的经皮冠状动脉介入治疗结果的信息有限。本研究的目的是描述与糖尿病和高血压相关的经皮冠状动脉介入治疗患者的结局。
从 5 个国家登记处提取数据：瑞典冠状动脉血管造影和血管成形术登记处（所有经皮冠状动脉介入治疗）、处方药物登记处（所有在瑞典药店购买的处方药物）、瑞典住院患者登记处（住院和专科保健中心的心肌梗死、血运重建、中风和充血性心力衰竭的数据）和国家人口登记处和死因登记处（死亡数据）。我们纳入了所有“首次经皮冠状动脉介入治疗”（2006 年 1 月 1 日至 2008 年 12 月 31 日），平均随访 1.9（±0.9）年。
死亡率为 6.4%，糖尿病合并高血压患者的死亡率最高。单纯高血压本身并不会增加死亡率或再次介入的风险，但会增加 10%的后续心肌梗死风险，当与糖尿病合并时，风险增加 4 倍。发生中风的患者为 2%；在非糖尿病患者中，高血压的重要性显而易见，但在糖尿病患者中更为明显。充血性心力衰竭导致 8%的患者住院，无论是否合并糖尿病，高血压都会产生负面影响。
经皮冠状动脉介入治疗后，采用现代药物治疗，糖尿病对预后有负面影响，尤其是与高血压合并时。单纯高血压本身与死亡率增加无关，但与心肌梗死、中风和充血性心力衰竭的风险增加有关，可能与广泛的冠状动脉疾病有关。改善糖尿病治疗可能会改善预后。
