接受冠状动脉生物可吸收支架治疗的糖尿病患者的三年随访结果
Three-years outcomes of diabetic patients treated with coronary bioresorbable scaffolds.
作者信息
Anadol Remzi, Schnitzler Katharina, Lorenz Liv, Weissner Melissa, Ullrich Helen, Polimeni Alberto, Münzel Thomas, Gori Tommaso
机构信息
Kardiologie I, Zentrum für Kardiologie, German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, University Hospital Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
出版信息
BMC Cardiovasc Disord. 2018 May 10;18(1):92. doi: 10.1186/s12872-018-0811-7.
BACKGROUND
Diabetes is among the strongest predictors of outcome after coronary artery stenting and the incidence of negative outcomes is still high in this specific group. Data of long-term outcomes comparing diabetic patients with non-diabetic patients treated with bioresorbable scaffolds are still incomplete. This work evaluates the long-term outcomes after implantation of a coronary bioresorbable scaffold (BRS) in diabetic patients compared to non-diabetics.
METHODS
Patients who received at least one Absorb BRS in the time of May 2012 to December 2014 were enrolled into this single-center registry. Quantitative coronary angiography (QCA) was performed.
RESULTS
Six hundred fifty seven patients including 138 patients (21%, mean age 65 ± 11, 78% male) with diabetes were enrolled. Patients in the diabetic group were significantly older, were more likely to suffer from hypertension and hyperlipidemia and had more often a prior stroke or TIA as well as a reduced renal function (all P < 0.05). The initial stenosis was less severe in the diabetic group (74.8% vs. 79.6%, P = 0.036), but the residual stenosis after BRS implantation exceeded that of the control group (16.7% vs. 13.8%, P = 0.006). History of diabetes had no impact on the incidence of events within one year after BRS implantation. Beyond 1 year, diabetic patients had a higher incidence of cardiovascular death (6.9 vs. 1.4%, HR:5.37 [1.33-21.71], P = 0.001), scaffold restenosis (17.6 vs. 7.8%, HR:3.56 [1.40-9.05], P < 0.0001) and target lesion revascularization (P = 0.016). These results were confirmed in the propensity score analysis. In both diabetics and non-diabetics, there was a strong association (HR:18.6 [4.7-73.3]) between the risk of restenosis and the technique used at implantation; in contrast, the impact of vessel size was more manifest in non-diabetics than in diabetic patients, and an increased risk of restenosis was demonstrated for both large and small vessels.
CONCLUSION
As for metal stents, beyond one year after implantation, diabetes was associated with an increased incidence of scaffold restenosis and related outcomes. This negative impact of diabetes was reset when an optimal implantation technique was used.
背景
糖尿病是冠状动脉支架置入术后预后的最强预测因素之一，在这一特定群体中不良预后的发生率仍然很高。比较接受生物可吸收支架治疗的糖尿病患者与非糖尿病患者长期预后的数据仍不完整。本研究评估了与非糖尿病患者相比，糖尿病患者植入冠状动脉生物可吸收支架（BRS）后的长期预后。
方法
纳入2012年5月至2014年12月期间至少接受一枚Absorb BRS的患者进入该单中心注册研究。进行定量冠状动脉造影（QCA）。
结果
共纳入657例患者，其中138例（21%，平均年龄65±11岁，78%为男性）患有糖尿病。糖尿病组患者年龄显著更大，更易患高血压和高脂血症，既往有中风或短暂性脑缺血发作（TIA）的情况更常见，且肾功能降低（所有P<0.05）。糖尿病组初始狭窄程度较轻（74.8%对79.6%，P=0.036），但BRS植入后的残余狭窄超过对照组（16.7%对13.8%，P=0.006）。糖尿病病史对BRS植入后1年内事件发生率无影响。1年后，糖尿病患者心血管死亡发生率更高（6.9%对1.4%，HR：5.37[1.33 - 21.71]，P=0.001），支架再狭窄发生率更高（17.6%对7.8%，HR：3.56[1.40 - 9.05]，P<0.0001）以及靶病变血运重建发生率更高（P=0.016）。这些结果在倾向评分分析中得到证实。在糖尿病患者和非糖尿病患者中，再狭窄风险与植入时使用的技术之间均存在强关联（HR：18.6[4.7 - 73.3]）；相比之下，血管大小的影响在非糖尿病患者中比在糖尿病患者中更明显，并且大小血管均显示出再狭窄风险增加。
结论
与金属支架一样，植入1年后，糖尿病与支架再狭窄及相关预后的发生率增加相关。当采用最佳植入技术时，糖尿病的这种负面影响得以消除。
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