Grodzinsky Anna, Kosiborod Mikhail, Tang Fengming, Jones Philip G, McGuire Darren K, Spertus John A, Beltrame John F, Jang Jae-Sik, Goyal Abhinav, Butala Neel M, Yeh Robert W, Arnold Suzanne V
From the Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G., M.K., F.T., P.G.J., J.A.S., J.-S.J., S.V.A.); University of Missouri-Kansas City (A.G., M.K., J.A.S., S.V.A.); Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.K.M.); The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Australia (J.F.B.); Division of Cardiology, Emory University School of Medicine, Atlanta, GA (A.G.); Massachusetts General Hospital Department of Medicine, Boston, MA (N.M.B.); and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston (R.W.Y.).
Circ Cardiovasc Qual Outcomes. 2017 Sep;10(9). doi: 10.1161/CIRCOUTCOMES.117.003553.
Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined.
In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [=0.01] and 32.8% versus 25.5% [=0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36).
Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia.
既往研究表明，在稳定型冠状动脉疾病患者中，与非糖尿病患者相比，糖尿病（DM）患者心绞痛较少，但无症状性心肌缺血较多。然而，近期尚未对择期经皮冠状动脉介入治疗（PCI）后糖尿病与非糖尿病患者的心绞痛负担进行研究。
在美国一个包含10个中心的PCI注册研究中，我们使用西雅图心绞痛问卷心绞痛频率评分（范围为0 - 100，分数越高越好）评估择期PCI术前及术后1、6和12个月时的心绞痛情况。我们还检查了出院时抗心绞痛药物的处方率。采用多变量重复测量泊松模型来研究治疗后一年内DM与心绞痛的独立关联。在1080例择期PCI患者中（平均年龄65岁；74.7%为男性），34.0%患有DM。在基线及每次随访时，DM患者与非DM患者的心绞痛患病率和严重程度相似。DM患者出院时更常被处方钙通道阻滞剂和长效硝酸盐类药物（DM患者与非DM患者分别为27.9%对20.9%[P = 0.01]和32.8%对25.5%[P = 0.01]），而β受体阻滞剂和雷诺嗪的处方率相似。在多变量重复测量模型中，PCI术后一年内，DM患者与非DM患者发生心绞痛的风险相似（相对风险为1.04；范围为0.80 - 1.36）。
尽管出院时抗心绞痛药物处方更多，但稳定型冠状动脉疾病合并DM的患者心绞痛负担至少与非DM患者一样高。这些发现与传统观点相悖，传统观点认为DM患者因无症状性心肌缺血而心绞痛较少。
