Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
Am J Cardiol. 2012 Sep 1;110(5):643-8. doi: 10.1016/j.amjcard.2012.04.043. Epub 2012 May 25.
Clinical outcomes in patients with diabetes mellitus and multivessel disease (MVD) undergoing coronary revascularization have not been extensively evaluated, we sought to examine outcomes in a diabetic cohort of 195 consecutive patients with MVD characterized by SYNTAX scores (SSs) undergoing nonrandomized revascularization, 102 (52%) by percutaneous intervention (PCI) and 93 (48%) by coronary artery bypass grafting (CABG) at Liverpool Hospital (Sydney, Australia) from June 2006 to March 2010. Clinical outcomes were assessed at a median term of 14 months. The overall median SS was 44, with significantly higher SSs in CABG- than PCI-treated patients (48 vs 39, p <0.0001). There was a similar incidence of all-cause death, nonfatal myocardial infarction and stroke in PCI- and CABG-treated patients (6.1% vs 8.3%, p = 0.383; 12% vs 4.9%, p = 0.152; 3.1% vs 3.5%, p = 0.680 respectively). However, the rates of target vessel revascularization and major adverse coronary and cerebral event were significantly higher in PCI-treated patients than in those undergoing CABG (20% vs 1.2%, p <0.0001; 29% vs 15%, p = 0.034). Despite a much higher SS, patients who underwent PCI achieved comparable outcomes at 1 year to those with diabetes mellitus and a SS ≥ 33 as reported in the SYNTAX trial. In conclusion, in this single-center nonrandomized observational study, coronary revascularization by PCI is associated with increased major adverse coronary and cerebral events at 1-year follow-up, predominantly driven by a high rate of target vessel revascularization. Thus, CABG should remain the revascularization procedure of choice for diabetic patients with MVD and high SSs.
患有糖尿病和多血管疾病（MVD）的患者在接受冠状动脉血运重建后的临床结果尚未得到广泛评估，我们试图检查在一个糖尿病队列中 195 例 MVD 患者的结果，这些患者的特征是 SYNTAX 评分（SS），他们接受了非随机血运重建，其中 102 例（52%）接受经皮介入治疗（PCI），93 例（48%）接受冠状动脉旁路移植术（CABG），地点是澳大利亚悉尼利物浦医院，时间是 2006 年 6 月至 2010 年 3 月。在中位 14 个月的时间内评估临床结果。总体中位数 SS 为 44，CABG 治疗患者的 SS 明显高于 PCI 治疗患者（48 与 39，p<0.0001）。在 PCI 和 CABG 治疗患者中，全因死亡、非致死性心肌梗死和卒中等的发生率相似（6.1%与 8.3%，p=0.383；12%与 4.9%，p=0.152；3.1%与 3.5%，p=0.680）。然而，在 PCI 治疗患者中，靶血管血运重建和主要不良冠状动脉和脑事件的发生率明显高于 CABG 治疗患者（20%与 1.2%，p<0.0001；29%与 15%，p=0.034）。尽管 SS 高得多，但与 SYNTAX 试验中报道的糖尿病和 SS≥33 的患者相比，接受 PCI 的患者在 1 年时获得了可比的结果。总之，在这项单中心非随机观察性研究中，PCI 血运重建与 1 年随访时主要不良冠状动脉和脑事件增加有关，主要是由于靶血管血运重建的高发生率。因此，对于 MVD 和高 SS 的糖尿病患者，CABG 应仍然是首选的血运重建方法。
