胰岛素治疗的2型糖尿病患者经皮冠状动脉介入治疗后心脏与非心脏相关死亡率的Meta分析

Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis.

作者信息

Wang Qiang, Liu Hao, Ding Jiawang

机构信息

Institute of Cardiovascular Diseases, Yichang Central People's Hospital, Yichang, 443000, Hubei, People's Republic of China.

Institute of Cardiovascular Diseases, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, People's Republic of China.

出版信息

Diabetes Ther. 2018 Jun;9(3):1335-1345. doi: 10.1007/s13300-018-0444-y. Epub 2018 May 19.

INTRODUCTION

Cardiovascular mortality is a major concern for patients with type 2 diabetes mellitus (T2DM). Insulin therapy significantly contributes to a high rate of death in these patients. We have performed a meta-analysis comparing cardiac and non-cardiac-related mortality following percutaneous coronary intervention (PCI) in a sample of patients with insulin-treated type 2 diabetes mellitus (ITDM).

METHODS

Studies were included in the meta-analysis if: (1) they were trials or cohort studies involving patients with T2DM post-PCI; (2) the outcomes in ITDM were separately reported; and (3) they reported cardiac death and non-cardiac death among their clinical endpoints. ITDM patients with any degree of coronary artery disease were included. The analysis was carried out using RevMan version 5.3 software, and data were reported with odds ratios (OR) and 95% confidence intervals (CI) as the main parameters.

RESULTS

A total of 4072 participants with ITDM were included, of whom 1658 participants and 2414 participants were extracted from randomized controlled trials and observational cohorts, respectively. Analysis of all data showed that death due to cardiac causes was significantly higher in patients with ITDM (OR 2.16, 95% CI 1.79-2.59; P = 0.00001). At 1 year of follow-up, cardiac death was still significantly higher compared to non-cardiac death (OR 2.39, 95% CI 1.47-3.88; P = 0.0004), and this result did not change with a longer follow-up period (3-5 years) (OR 2.09, 95% CI 1.70-2.56; P = 0.00001). Death due to cardiac causes was still significantly higher in the subpopulations of patients with everolimus-eluting stents (OR 2.31, 95% CI 1.26-4.26; P = 0.007), paclitaxel-eluting stents (OR 2.36, 95% CI 1.63-3.39; P = 0.00001), sirolimus-eluting stents (OR 2.11, 95% CI 1.67-2.67; P = 0.00001), and zotarolimus-eluting stents (OR 2.12, 95% CI 1.11-4.05; P = 0.02), respectively.

CONCLUSIONS

Mortality due to cardiac causes was significantly higher than that due to non-cardiac causes in patients with ITDM who had undergone PCI. The same conclusion could be drawn from analyses focused on different follow-up periods, types of coronary stents, and type of study data used.

引言

心血管疾病死亡率是2型糖尿病（T2DM）患者的主要担忧。胰岛素治疗显著导致这些患者的高死亡率。我们进行了一项荟萃分析，比较接受经皮冠状动脉介入治疗（PCI）的胰岛素治疗的2型糖尿病（ITDM）患者样本中心脏相关死亡率和非心脏相关死亡率。

方法

符合以下条件的研究纳入荟萃分析：（1）它们是涉及PCI术后T2DM患者的试验或队列研究；（2）分别报告了ITDM患者的结局；（3）它们在临床终点中报告了心脏死亡和非心脏死亡。纳入任何程度冠状动脉疾病的ITDM患者。使用RevMan 5.3版软件进行分析，并以比值比（OR）和95%置信区间（CI）作为主要参数报告数据。

结果

总共纳入了4072名ITDM参与者，其中分别从随机对照试验和观察性队列中提取了1658名参与者和2414名参与者。对所有数据的分析表明，ITDM患者因心脏原因导致的死亡显著更高（OR 2.16，95% CI 1.79 - 2.59；P = 0.00001）。在随访1年时，心脏死亡仍显著高于非心脏死亡（OR 2.39，95% CI 1.47 - 3.88；P = 0.0004），并且在更长的随访期（3 - 5年）该结果未改变（OR 2.09，95% CI 1.70 - 2.56；P = 0.00001）。在使用依维莫司洗脱支架、紫杉醇洗脱支架、西罗莫司洗脱支架和佐他莫司洗脱支架的患者亚组中，因心脏原因导致的死亡也分别显著更高（OR分别为2.31，95% CI 1.26 - 4.26；P = 0.007；OR 2.36，95% CI 1.63 - 3.39；P = 0.00001；OR 2.11，95% CI 1.67 - 2.67；P = 0.00001；OR 2.12，95% CI 1.11 - 4.05；P = 0.02）。