Muneretto Claudio, Bisleri Gianluigi, Negri Alberto, Piccoli Paolo, Nodari Savina, Dei Cas Livio
Division of Cardiac Surgery, University of Brescia Medical School, Brescia - Italy.
Heart Int. 2006;2(3-4):136. doi: 10.4081/hi.2006.136. Epub 2006 Dec 15.
Diabetes negatively affects the outcome of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) or coronary surgery. However, data are lacking with respect to the impact of arterial revascularization in the diabetic population.
Between 1999 and 2003, 100 of 491 diabetics underwent coronary artery bypass graft surgery (CABG) with total arterial grafting (Group 1, G1); these patients were compared with 100 diabetics undergoing conventional CABG with saphenous veins (Group 2, G2), who were matched for Euroscore and other risk factors such as age, obesity, hypertension, left ventricular ejection fraction (LVEF), previous myocardial infarction and chronic obstructive pulmonary disease (COPD).
Both groups had a similar number of diseased coronary vessels (G1=2.6 vs G2= 2.7) and received a similar degree of myocardial revascularization (grafted vessels: G1=2.2 vs G2=2.4). Early outcome was comparable between the groups in terms of ventilatory support (G1=10.8±6 vs G2=10.4±5 hours), intensive care unit (ICU) stay (G1=24±12 vs G2=25±14 hours) and major post-operative complications such as atrial fibrillation (G1=26% vs G2=28%), peri-operative myocardial infarction (G1=1% vs G2=2%)and prolonged ventilatory support (G1=6% vs G2=5%). Hospital mortality was 2% in G1 and 3% in G2. Angiography was performed at a mean follow-up of 34 months in 65.9% and 71.1% of hospital survivors of G1 and G2 respectively: patients of G1 showed a significantly higher patency rate (G1=96% vs G2=83.6%, p=0.02). Additionally, patients of G1 showed a significantly lower incidence of recurrent myocardial ischemia (G1=7 pts. vs G2=18 pts., p=0.03), late myocardial infarction (G1=2 pts. vs G2=10 pts., p=0.03) and need for coronary reintervention (G1=1 pt. vs G2=12 pts, p=0.004).
Total arterial grafting in diabetic patients significantly improved the benefits of coronary surgery providing at mid term a higher graft patency rate with a lower incidence of cardiac related events.
糖尿病对接受经皮腔内冠状动脉成形术（PTCA）或冠状动脉手术的患者的预后产生负面影响。然而，关于动脉血运重建对糖尿病患者的影响的数据尚缺乏。
1999年至2003年间，491例糖尿病患者中的100例接受了全动脉搭桥冠状动脉旁路移植术（CABG）（第1组，G1）；将这些患者与100例接受传统大隐静脉CABG的糖尿病患者（第2组，G2）进行比较，后者在欧洲心脏手术风险评估系统（Euroscore）以及年龄、肥胖、高血压、左心室射血分数（LVEF）、既往心肌梗死和慢性阻塞性肺疾病（COPD）等其他风险因素方面进行了匹配。
两组的病变冠状动脉数量相似（G1 = 2.6对G2 = 2.7），心肌血运重建程度相似（移植血管：G1 = 2.2对G2 = 2.4）。两组在通气支持（G1 = 10.8±6对G2 = 10.4±5小时）、重症监护病房（ICU）住院时间（G1 = 24±12对G2 = 25±14小时）以及主要术后并发症如房颤（G1 = 26%对G2 = 28%）、围手术期心肌梗死（G1 = 1%对G2 = 2%）和通气支持延长（G1 = 6%对G2 = 5%）方面的早期预后相当。G1组的医院死亡率为2%，G2组为3%。G1组和G2组分别有65.9%和71.1%的医院幸存者在平均随访34个月时进行了血管造影：G1组患者的通畅率显著更高（G1 = 96%对G2 = 83.6%，p = 0.02）。此外，G1组患者复发性心肌缺血（G1 = 7例对G2 = 18例，p = 0.03）、晚期心肌梗死（G1 = 2例对G2 = 10例，p = 0.03）和冠状动脉再次干预需求（G1 = 1例对G2 = 12例，p = 0.004）的发生率显著更低。
糖尿病患者的全动脉搭桥显著改善了冠状动脉手术的益处，在中期提供了更高的移植血管通畅率和更低的心脏相关事件发生率。
