Guelker Jan-Erik, Bansemir Lars, Ott Rainer, Rock Thomas, Guelker Rosemarie, Shin Dong-In, Klues Heinrich, Bufe Alexander
Department of Cardiology, Heart Centre Niederrhein, Helios Clinic Krefeld, Krefeld, Germany.
Institute for Heart and Circulation Research, University Cologne, Cologne, Germany.
J Tehran Heart Cent. 2019 Apr;14(2):47-52.
Percutaneous coronary intervention (PCI) of total chronic coronary occlusions (CTOs) still remains a major challenge in interventional cardiology. There is little knowledge in the literature about differences in CTO-PCI between diabetic and nondiabetic patients in the era of third-generation drug-eluting stents (DESs). In this study, we analyzed the impact of diabetes mellitus (DM) on procedural characteristics, complications, and acute outcomes in a cohort of 440 patients. Between 2012 and 2016, we recruited 440 consecutive patients, 116 of them with DM. All the patients underwent PCI for at least 1 CTO. Antegrade and retrograde CTO recanalization techniques were applied. Only third-generation DESs were used. We used t-tests and the Pearson chi-quadrat test to test the significant differences in the variables between the 2 groups. The patients with DM were older than the nondiabetics (64.5 y vs. 61.1 y; P=0.003), and they suffered more frequently from a chronic kidney disease (7.1% vs. 2.4%; P=0.001). The nondiabetics less frequently had arterial hypertension (75.3% vs. 89.7%; P=0.001); however, they more often had a family liability for CAD (32.1% vs. 22.4%; P=0.050) and had a higher left ventricular ejection fraction (59.2% vs. 56.7%; P=0.011). The success rate was 85.2% in the patients without DM and 81.2% in the patients with DM (P=0.403). The existence of DM had no impact on the procedural success and complication rates. Our study on 440 patients shows that diabetics and nondiabetics have similar success and complication rates after the recanalization of CTOs using third-generation DESs. It is a feasible and safe procedure and can be recommended as an alternative treatment.
完全慢性冠状动脉闭塞病变（CTO）的经皮冠状动脉介入治疗（PCI）仍是介入心脏病学中的一项重大挑战。在第三代药物洗脱支架（DES）时代，关于糖尿病患者与非糖尿病患者在CTO-PCI方面差异的文献报道较少。在本研究中，我们分析了糖尿病（DM）对440例患者的手术特征、并发症及急性预后的影响。2012年至2016年期间，我们连续招募了440例患者，其中116例患有DM。所有患者均接受了至少1处CTO的PCI治疗。采用正向和逆向CTO再通技术。仅使用第三代DES。我们使用t检验和Pearson卡方检验来检验两组之间变量的显著差异。DM患者比非DM患者年龄更大（64.5岁对61.1岁；P=0.003），且更频繁地患有慢性肾脏病（7.1%对2.4%；P=0.001）。非DM患者患动脉高血压的频率较低（75.3%对89.7%；P=0.001）；然而，他们患CAD的家族倾向更常见（32.1%对22.4%；P=0.050），且左心室射血分数更高（59.2%对56.7%；P=0.011）。非DM患者的成功率为85.2%，DM患者为81.2%（P=0.403）。DM的存在对手术成功率和并发症发生率无影响。我们对440例患者的研究表明，使用第三代DES对CTO进行再通后，糖尿病患者和非糖尿病患者的成功率和并发症发生率相似。这是一种可行且安全的手术，可作为替代治疗方法推荐。
