Lin Mao-Jen, Chang Yu-Jun, Chen Chun-Yu, Huang Chia-Chen, Chuang Tzu-Yao, Wu Han-Ping
Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung.
Department of Medicine, School of Medicine, Tzu Chi University, Hualien.
Medicine (Baltimore). 2019 Aug;98(34):e16927. doi: 10.1097/MD.0000000000016927.
Coronary artery disease (CAD) is a life-threatening medical emergency which needs urgent medical attention. Percutaneous coronary intervention (PCI) is common and necessary for patients with CAD. The effect of hypercholesterolemia and diabetes on long-term outcomes in patients with stable CAD receiving PCI is unclear.In this study, patients with stable CAD who underwent PCI were prospectively divided into 4 groups according to the presence or absence of diabetes or hypercholesterolemia. Clinical characteristics, risk factors, medications, angiographic findings, and outcome predictors were analyzed and long-term outcomes compared between groups.Of the 1676 patients studied, those with hypercholesterolemia and diabetes had the highest all-cause mortality rate after PCI (P < .01); those with diabetes only had the highest cardiovascular (CV) mortality (P < .01). However, the 4 groups did not differ in rates of myocardial infarction (MI) or repeated PCI. In Kaplan-Meier survival analysis, patients with diabetes only had the highest rates of all-cause mortality and CV mortality (both P < .001). In the Cox proportional hazard model, patients with both hypercholesterolemia and diabetes had the highest risk of all-cause mortality (hazard ratio: 1.70), but groups did not differ in rates of MI, CV mortality, and repeated PCI.With or without hypercholesterolemia, diabetes adversely impacts long-term outcomes in patients receiving PCI. Diabetes mellitus seemed to be a more hazardous outcome predictor than hypercholesterolemia. Hypercholesterolemia and diabetes seemed to have an additive effect on all-cause mortality in patients after receiving PCI.
冠状动脉疾病(CAD)是一种危及生命的医疗急症,需要紧急医疗关注。经皮冠状动脉介入治疗(PCI)对于CAD患者来说很常见且必要。高胆固醇血症和糖尿病对接受PCI的稳定型CAD患者长期预后的影响尚不清楚。在本研究中,接受PCI的稳定型CAD患者根据是否患有糖尿病或高胆固醇血症被前瞻性地分为4组。分析了临床特征、危险因素、用药情况、血管造影结果和预后预测因素,并比较了各组之间的长期预后。在研究的1676例患者中,患有高胆固醇血症和糖尿病的患者PCI术后全因死亡率最高(P<0.01);仅患有糖尿病的患者心血管(CV)死亡率最高(P<0.01)。然而,4组在心肌梗死(MI)或再次PCI发生率方面没有差异。在Kaplan-Meier生存分析中,仅患有糖尿病的患者全因死亡率和CV死亡率最高(均P<0.001)。在Cox比例风险模型中,同时患有高胆固醇血症和糖尿病的患者全因死亡风险最高(风险比:1.70),但各组在MI发生率、CV死亡率和再次PCI发生率方面没有差异。无论有无高胆固醇血症,糖尿病都会对接受PCI的患者长期预后产生不利影响。糖尿病似乎是比高胆固醇血症更危险的预后预测因素。高胆固醇血症和糖尿病在接受PCI的患者全因死亡率方面似乎具有相加作用。