Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, 7 Michal St., 3436212, Haifa, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Cardiovasc Diabetol. 2018 Feb 5;17(1):25. doi: 10.1186/s12933-018-0669-0.
Coronary artery disease often progresses more rapidly in diabetics, but the integrated impact of diabetes and early revascularization status on late or repeat revascularization in the contemporary era is less clear.
Coronary angiography was performed in 12,420 patients between the years 2000-2015 and early revascularization status [none, percutaneous coronary intervention (PCI) or bypass surgery (CABG)] was determined. Subsequent revascularization procedures were recorded over a median follow-up of 67 months and its relation to diabetic and baseline revascularization status was studied.
Early revascularization status was none in 5391, PCI in 5682 and CABG in 1347 patients. Late revascularization rates were 10, 26 and 11.1% respectively. Diabetes was present in 37%; a stepwise relationship of diabetic status with late revascularization was observed: no diabetes (reference) 14.4%, non-insulin treated diabetes 21% (adjusted HR 1.35, 95% CI 1.23-1.49, p < 0.001) and insulin-treated diabetes 32.8% (adjusted HR 2.20, 95% CI 1.91-2.54, p < 0.001), which was similar in magnitude for each early revascularization state (none, PCI or CABG). Further revascularizations (≥ 2) were also significantly more common in diabetics, in particular if insulin-treated. Glycosylated hemoglobin level was moderately associated with late revascularization in diabetics after early PCI but not following diagnostic catheterization or CABG.
Diabetic status graded by treatment, and in particular insulin therapy, is a strong predictor for late or repeat revascularization irrespective of early revascularization status. The high rate of repeat revascularization in diabetics following PCI remains a challenging issue.
冠心病在糖尿病患者中通常进展得更快，但在当代，糖尿病和早期血运重建状况对晚期或再次血运重建的综合影响尚不清楚。
在 2000 年至 2015 年期间对 12420 例患者进行了冠状动脉造影，并确定了早期血运重建状况（无、经皮冠状动脉介入治疗（PCI）或旁路手术（CABG））。在中位随访 67 个月期间记录了随后的血运重建手术，并研究了其与糖尿病和基线血运重建状况的关系。
早期血运重建状态无的患者有 5391 例，PCI 的患者有 5682 例，CABG 的患者有 1347 例。晚期血运重建率分别为 10%、26%和 11.1%。37%的患者存在糖尿病；观察到糖尿病状态与晚期血运重建之间呈逐步关系：无糖尿病（参考）14.4%，非胰岛素治疗的糖尿病 21%（调整后的 HR 1.35，95%CI 1.23-1.49，p<0.001），胰岛素治疗的糖尿病 32.8%（调整后的 HR 2.20，95%CI 1.91-2.54，p<0.001），每种早期血运重建状态（无、PCI 或 CABG）的相关性相似。如果接受胰岛素治疗，糖尿病患者也明显更常见进行进一步的血运重建（≥2 次）。在早期 PCI 后，糖化血红蛋白水平与糖尿病患者的晚期血运重建中度相关，但在诊断性导管检查或 CABG 后则没有。
根据治疗情况（特别是胰岛素治疗）对糖尿病状态进行分级，是晚期或再次血运重建的强有力预测因素，与早期血运重建状况无关。在接受 PCI 的糖尿病患者中，再次血运重建的高发生率仍然是一个具有挑战性的问题。
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