Wang J, Xu H B, Zhang H P, Chen J L, Qiao S B, Hu F H, Yang W X, Yuan J S, Liu R, Cui J G, Guo C, Duan X, Gao L J
Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 May 24;48(5):393-400. doi: 10.3760/cma.j.cn112148-20190425-00204.
To investigate the impact of type 2 diabetes mellitus on progression and revascularization of coronary non-target lesions in patients with coronary heart disease. From January 2010 to September 2014, we retrospectively analyzed the clinical data of patients with coronary heart disease who underwent two consecutive coronary angiographies at Fuwai Hospital. At least one coronary non-target lesion was recorded at the first procedure in these patients. Patients were grouped according to the diagnose of type 2 diabetes mellitus. Demographic features, risk factors of coronary heart disease, laboratory results as well as characteristics of coronary non-target lesions were collected at baseline (first coronary angiography) and follow-up (second coronary angiography). Lesion progression was defined by quantitative coronary angiography analysis. Lesions revascularization was recorded. Multivariable Cox regression analysis was used to define the impacts of diabetes mellitus on progression and revascularization of non-target lesions. Subgroup analysis in diabetic and non-diabetic groups were further performed. Receiver operating characteristics curve was used to identify the predictive value of HbA1c. A total of 1 255 patients were included, and 1 003(79.9%) were male, age was(58.0±9.7) years old. And 486 patients were diagnosed with type 2 diabetes mellitus. Follow-up time was (14.8±4.5) months. Compared with non-diabetic group, diabetic group were older with less male and had higher BMI index as well as higher prevalence of hypertension, dyslipidemia, prior myocardial infarction and prior percutaneous coronary intervention(all 0.05). Diabetic patients also had higher level of white blood cells, erythrocyte sedimentation rate, C-reactive protein, endothelin and HbA1c at both baseline and follow-up compared with non-diabetic patients (all 0.01). There was no significant difference on progression of non-target lesions (20.0%(97/486) vs. 18.5%(142/769), 0.512), revascularization of non-target lesions (13.2%(64/486) vs. 15.9%(122/769), 0.190) and non-target lesion related myocardial infarction(1.9%(9/486) vs. 1.3%(10/769), 0.436) between diabetic and non-diabetic patients. Multivariable Cox regression analysis revealed that diabetes mellitus was not an independent predictor for progression and revascularization of non-target lesions (Both 0.05). Subgroup analysis in diabetic patients showed that baseline HbA1c level(=1.160, 95 1.009-1.333, 0.037) was an independent predictor for non-target lesion progression. Cut-off value of HbA1c was 6.5% (Area Under Curve(AUC) 0.57, specificity 88.7%; sensitivity 24.2%, 0.046) by receiver operating characteristics curve. Patients with HbA1c level above 6.5% had 2.8 times higher risk of lesion progression compared with patients with HbA1c level below 6.5% (=2.838, 95 1.505-5.349, 0.001). Compared with non-diabetic patients, diabetic patients with HbA1c below 6.5% also had lower risk of lesion progression (=0.469, 95 0.252-0.872, 0.012). ST-segment elevated myocardial infarction was an independent predictor for revascularization of non-target lesions in diabetic patients. Type 2 diabetes mellitus is not an independent predictor for progression and revascularization of coronary non-target lesions in patients with coronary heart disease. However, elevated HbA1c level is a risk factor for progression of non-target lesion in patients with type 2 diabetes mellitus.
探讨2型糖尿病对冠心病患者冠状动脉非靶病变进展及血运重建的影响。2010年1月至2014年9月，我们回顾性分析了在阜外医院连续接受两次冠状动脉造影的冠心病患者的临床资料。这些患者在首次检查时至少记录有一处冠状动脉非靶病变。根据2型糖尿病诊断将患者分组。在基线（首次冠状动脉造影）和随访（第二次冠状动脉造影）时收集人口统计学特征、冠心病危险因素、实验室检查结果以及冠状动脉非靶病变特征。通过定量冠状动脉造影分析定义病变进展情况。记录病变血运重建情况。采用多变量Cox回归分析确定糖尿病对非靶病变进展及血运重建的影响。进一步在糖尿病组和非糖尿病组中进行亚组分析。采用受试者工作特征曲线确定糖化血红蛋白（HbA1c）的预测价值。共纳入1255例患者，其中男性1003例（79.9%），年龄为（58.0±9.7）岁。486例患者被诊断为2型糖尿病。随访时间为（14.8±4.5）个月。与非糖尿病组相比，糖尿病组年龄更大，男性更少，体重指数更高，高血压、血脂异常、既往心肌梗死及既往经皮冠状动脉介入治疗的患病率更高（均P<0.05）。糖尿病患者在基线和随访时白细胞、红细胞沉降率、C反应蛋白、内皮素及HbA1c水平也高于非糖尿病患者（均P<0.01）。糖尿病患者与非糖尿病患者在非靶病变进展（20.0%（97/486）对18.5%（142/769），P=0.512）、非靶病变血运重建（13.2%（64/486）对15.9%（122/769），P=0.190）及非靶病变相关心肌梗死（1.9%（9/486）对1.3%（10/769），P=0.436）方面无显著差异。多变量Cox回归分析显示，糖尿病不是非靶病变进展及血运重建的独立预测因素（均P>0.05）。糖尿病患者亚组分析显示，基线HbA1c水平（β=1.160，95%CI 1.009-1.333，P=0.037）是非靶病变进展的独立预测因素。通过受试者工作特征曲线，HbA1c的截断值为6.5%（曲线下面积（AUC）0.57，特异性88.7%；敏感性24.2%，P=0.046）。HbA1c水平高于6.5%的患者病变进展风险是HbA1c水平低于6.5%患者的2.8倍（β=2.838，95%CI 1.505-5.349，P=0.001）。与非糖尿病患者相比，HbA1c低于6.5%的糖尿病患者病变进展风险也更低（β=0.469，95%CI 0.252-0.872，P=0.012）。ST段抬高型心肌梗死是糖尿病患者非靶病变血运重建情况的独立预测因素。2型糖尿病不是冠心病患者冠状动脉非靶病变进展及血运重建的独立预测因素。然而，HbA1c水平升高是2型糖尿病患者非靶病变进展的危险因素。
