药物洗脱支架时代成功进行经皮冠状动脉介入治疗慢性完全闭塞病变后糖尿病患者与非糖尿病患者的比较。
Comparison between diabetic and non-diabetic patients after successful percutaneous coronary intervention for chronic total occlusions in the drug-eluting stent era.
作者信息
Ruiz-Garcia Juan, Teles Rui, Rumoroso José-Ramón, Cyrne Carvalho Henrique, Goicolea Francisco Javier, Moreu José, Mauri Josefa, Mainar Vicente, García Eulogio, Moreno Raul
机构信息
Sección de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Quiron, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de Torrejón, Madrid, Spain.
Servicio de Cardiología, Hospital de Santa Cruz, Lisboa, Portugal.
出版信息
Rev Port Cardiol. 2015 Apr;34(4):263-70. doi: 10.1016/j.repc.2014.10.009. Epub 2015 Apr 1.
OBJECTIVE
Diabetes mellitus and chronic total occlusions are associated with unfavorable outcome after percutaneous coronary intervention. We sought to assess the clinical and angiographic outcomes of diabetic and non-diabetic patients who underwent successful percutaneous revascularization of chronic total occlusions with drug-eluting stents.
METHODS
Baseline clinical and angiographic characteristics, procedural details, nine-month angiographic follow-up and clinical events at 12 months were compared between 75 diabetic and 132 non-diabetic patients included in a clinical trial that randomized successful recanalization of chronic total occlusions to receive sirolimus- or everolimus-eluting stents.
RESULTS
In both diabetic and non-diabetic groups there was a favorable non-significantly different angiographic result at nine months, with low in-stent late loss (0.14±0.60 mm vs. 0.25±0.68 mm, p=0.305) and rates of binary restenosis (4.0% vs. 10.6%, p=0.180) and reocclusion (0.0% vs. 2.3%, p=0.334). During follow-up similar survival from death (97.3±1.9% vs. 99.2±0.8%, log-rank p=0.273), acute myocardial infarction (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192), target vessel revascularization (88.7±3.8% vs. 88.2±2.9%, log-rank p=0.899) and stent thrombosis (100.0±0.0% vs. 97.7±1.3%, log-rank p=0.192) was observed. Furthermore, the presence of more diffuse peripheral and coronary artery disease and higher frequency of calcified lesions in diabetic patients did not lead to significant differences in the approach (20.0% vs. 25.0% radial approach, p=0.413), strategy (6.7% vs. 3.8% retrograde strategy, p=0.353), total stent length (48.1±24.6 mm vs. 49.2±23.9 mm, p=0758) or contrast volume (261.3±116.4 ml vs. 297.4±135.9 ml, p=0.109) required for revascularization.
CONCLUSIONS
In the drug-eluting stent era, diabetic and non-diabetic patients have comparable favorable clinical and angiographic outcomes after successful percutaneous revascularization of chronic total occlusions.
目的
糖尿病和慢性完全闭塞与经皮冠状动脉介入治疗后的不良预后相关。我们旨在评估接受药物洗脱支架成功进行慢性完全闭塞经皮血管重建的糖尿病和非糖尿病患者的临床和血管造影结果。
方法
在一项临床试验中，将75例糖尿病患者和132例非糖尿病患者纳入研究，这些患者均成功实现慢性完全闭塞再通并接受西罗莫司或依维莫司洗脱支架治疗，比较了他们的基线临床和血管造影特征、手术细节、9个月的血管造影随访以及12个月时的临床事件。
结果
糖尿病组和非糖尿病组在9个月时血管造影结果均良好，组间差异无统计学意义，支架内晚期管腔丢失较低（0.14±0.60 mm对0.25±0.68 mm，p = 0.305），二元再狭窄率（4.0%对10.6%，p = 0.180）和再闭塞率（0.0%对2.3%，p = 0.334）。随访期间，两组在死亡生存率（97.3±1.9%对99.2±0.8%，对数秩检验p = 0.273）、急性心肌梗死发生率（100.0±0.0%对97.7±1.3%，对数秩检验p = 0.192）、靶血管再血管化率（88.7±3.8%对88.2±2.9%，对数秩检验p = 0.899）和支架血栓形成率（100.0±0.0%对97.7±1.3%，对数秩检验p = 0.192）方面相似。此外，糖尿病患者更广泛的外周和冠状动脉疾病以及更高频率的钙化病变，在血管重建的入路（20.0%对25.0%桡动脉入路，p = 0.413）、策略（6.7%对3.8%逆行策略，p = 0.353）、总支架长度（48.1±24.6 mm对49.2±23.9 mm，p = 0.758）或所需造影剂用量（261.3±116.4 ml对297.4±135.9 ml，p = 0.109）方面未导致显著差异。
结论
在药物洗脱支架时代，糖尿病和非糖尿病患者在成功进行慢性完全闭塞经皮血管重建后，具有相当的良好临床和血管造影结果。
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