Lu Hongtao, Tang Bing, Zhou Yanhua, Xu Chenhong, Bundhun Pravesh Kumar, Tang Zhangui, Bao Hong
Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, People's Republic of China.
Department of Hematology, Jingzhou First People's Hospital, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, People's Republic of China.
Diabetes Ther. 2019 Aug;10(4):1487-1497. doi: 10.1007/s13300-019-0656-9. Epub 2019 Jun 29.
Type 2 diabetes mellitus (T2DM) is a major health issue, especially in patients with coexisting coronary artery disease (CAD). Patients with insulin-treated T2DM (ITDM) have worse outcomes than those with non-insulin-treated T2DM. Very few studies have compared short-term to long-term adverse cardiovascular outcomes following percutaneous coronary intervention (PCI) in patients on insulin therapy. Therefore, in this meta-analysis, we systematically compared short-term to long-term adverse cardiovascular outcomes in a population of patients with ITDM following PCI.
We searched for English-language publications focusing on PCI in patients with ITDM using specific search terms/phrases. All the participants accepted for inclusion in this meta-analysis were treated with a drug-eluting stent. Post-intervention adverse cardiovascular outcomes observed during short-term and long-term follow-up periods were assessed and compared. Statistical analysis was carried out using the popular RevMan 5.3 software. Odd ratios (OR) with 95% confidence intervals (CI) were calculated.
Six studies comprising 1568 participants with ITDM in total were included in this simple meta-analysis. Patient enrollment periods varied but enrollment occurred during the years 1993-2012. When a fixed-effects statistical model was used, post-PCI adverse cardiovascular outcomes-such as major adverse cardiac events (MACEs) (OR 3.33, 95% CI 2.64-4.21; P = 0.00001), all-cause mortality (OR 5.73, 95% CI 3.37-9.73; P = 0.00001), myocardial infarction (MI) (OR 1.47, 95% CI 1.05-2.07; P = 0.02), and repeated revascularization (OR 4.78, 95% CI 3.29-6.94; P = 0.00001)-were found to be significantly more likely during the long-term follow-up period. A similar result was observed with a random-effects statistical model.
Adverse cardiovascular outcomes post PCI were significantly more likely during the long-term follow-up period than during the short-term follow-up period in these patients with T2DM on insulin therapy. This hypothesis requires confirmation via new comparative trials that consider short-term and long-term follow-up periods.
2型糖尿病（T2DM）是一个主要的健康问题，尤其是在合并冠状动脉疾病（CAD）的患者中。接受胰岛素治疗的2型糖尿病（ITDM）患者的预后比未接受胰岛素治疗的2型糖尿病患者更差。很少有研究比较胰岛素治疗患者经皮冠状动脉介入治疗（PCI）后短期与长期的不良心血管结局。因此，在这项荟萃分析中，我们系统地比较了ITDM患者PCI后短期与长期的不良心血管结局。
我们使用特定的搜索词/短语搜索聚焦于ITDM患者PCI的英文出版物。所有纳入本荟萃分析的参与者均接受药物洗脱支架治疗。评估并比较短期和长期随访期间观察到的干预后不良心血管结局。使用流行的RevMan 5.3软件进行统计分析。计算了具有95%置信区间（CI）的比值比（OR）。
本简单荟萃分析纳入了6项研究，共计1568例ITDM患者。患者入组时间各不相同，但入组时间为1993年至2012年。当使用固定效应统计模型时，PCI后不良心血管结局，如主要不良心脏事件（MACE）（OR 3.33，95%CI 2.64 - 4.21；P = 0.00001）、全因死亡率（OR 5.73，95%CI 3.37 - 9.73；P = 0.00001）、心肌梗死（MI）（OR 1.47，95%CI 1.05 - 2.07；P = 0.02）和再次血运重建（OR 4.78，95%CI 3.29 - 6.94；P = 0.00001），在长期随访期间被发现显著更有可能发生。随机效应统计模型也观察到了类似结果。
在这些接受胰岛素治疗的2型糖尿病患者中，PCI后不良心血管结局在长期随访期间比短期随访期间显著更有可能发生。这一假设需要通过考虑短期和长期随访期的新的对比试验来证实。
