[药物洗脱支架植入术后2年内合并糖尿病的冠心病患者支架内再狭窄的预测因素]

[Predictors of in-stent restenosis in coronary heart disease patients complicating with diabetes mellitus within 2 years after drug-eluting stents implantation].

作者信息

Chen Jinsong, Chen Yundai, Tian Feng, Han Yunfeng, Jing Jing, Liu Jie, Wang Jing, Zhou Shanshan

机构信息

Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.

Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China. Email:

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2014 Jan;42(1):14-8.

PMID:24680263

Abstract

OBJECTIVE

To determine predictors for in-stent restenosis (ISR) within 2 years after drug-eluting stent (DES) implantation in coronary heart disease patients complicating with diabetes mellitus and to establish predictive model.

METHODS

We retrospectively analyzed clinical data of patients underwent DES implantation in our hospital between January 2005 and December 2012. Using random number generated by SPSS 17.0, a total of 3 073 cases were randomly divided into two cohort, model derivation cohort (MDC) and model validation cohort (MVC). MDC (2 048 cases) was divided into in-stent restenosis (ISR) group and control group. Predictors were identified using univariable and multivariable logistic regression analysis in MDC. Integer point values were assigned to each predictor based upon their β coefficient in multivariable logistic regression model to establish scoring model. The summed scores of each case in MVC (1 025 cases) were calculated to test predictive ability of the model.

RESULTS

Of all these 3 073 cases, 217 cases (7.1%) were diagnosed with ISR within 2 year after DES implantation. The incidence of ISR within 2 year after DES implantation was 7.3% (149 cases) in MDC and logistic regression analysis identified six ISR risk factors: multiple target vessels (OR = 3.69, 95%CI: 2.65-8.93, P = 0.000), diffused lesions (OR = 2.92, 95%CI: 2.03-6.46, P = 0.000), GFR < 60 ml×min(-1)·1.73 m(-2) (OR = 4.73, 95%CI: 3.51-10.62, P = 0.000), smoking (OR = 3.37, 95%CI: 2.39-8.46, P = 0.000), age < 60 years old (OR = 1.44, 95%CI:1.26-4.63, P = 0.024), HbAlc ≥ 6.3% (OR = 2.48, 95%CI: 1.84-4.27, P = 0.002). Risk score was well associated with the rate of ISR in MVC. Sensitivity was 76.5% (95%CI: 64.6%-85.9%), specificity was 76.1% (95%CI: 73.2%-78.7%), and areas under the ROC curve was 0.851(95%CI:0.813-0.890, P = 0.000) when score was set at 5.5.

CONCLUSIONS

The incidence of ISR in coronary heart disease patients complicating with diabetes mellitus within 2 years after DES implantation is relatively low. Several factors are associated with ISR in these patients and risk for ISR could be reliably identified by the established scoring model.

摘要

目的

确定冠心病合并糖尿病患者药物洗脱支架（DES）植入后2年内支架内再狭窄（ISR）的预测因素，并建立预测模型。

方法

回顾性分析2005年1月至2012年12月在我院接受DES植入的患者的临床资料。使用SPSS 17.0生成的随机数，将3073例患者随机分为两个队列，即模型推导队列（MDC）和模型验证队列（MVC）。MDC（2048例）分为支架内再狭窄（ISR）组和对照组。在MDC中使用单变量和多变量逻辑回归分析确定预测因素。根据多变量逻辑回归模型中各预测因素的β系数为其赋予整分值，以建立评分模型。计算MVC（1025例）中各病例的总分，以检验模型的预测能力。

结果

在这3073例患者中，217例（7.1%）在DES植入后2年内被诊断为ISR。MDC中DES植入后2年内ISR的发生率为7.3%（149例），逻辑回归分析确定了6个ISR危险因素：多支靶血管（OR = 3.69，95%CI：2.65 - 8.93，P = 0.000）、弥漫性病变（OR = 2.92，95%CI：2.03 - 6.46，P = 0.000）、肾小球滤过率（GFR）< 60 ml×min⁻¹·1.73 m⁻²（OR = 4.73，95%CI：3.51 - 10.62，P = 0.000）、吸烟（OR = 3.37，95%CI：2.39 - 8.46，P = 0.000）、年龄< 60岁（OR = 1.44，95%CI：1.26 - 4.63，P = 0.024）、糖化血红蛋白（HbAlc）≥ 6.3%（OR = 2.48，95%CI：1.84 - 4.27，P = 0.002）。风险评分与MVC中ISR的发生率密切相关。当评分为5.5时，敏感性为76.5%（95%CI：64.6% - 85.9%），特异性为76.1%（95%CI：73.2% - 78.7%），ROC曲线下面积为0.851（95%CI：0.813 - 0.890，P = 0.000）。