2型糖尿病患者中通过SYNTAX评分评估心肌血运重建的适宜性：PROUST研究
ApPropRiateness of myOcardial revascUlarization assessed by SYNTAX Scores in patients with type 2 diabetes melliTus: the PROUST study.
作者信息
Stanetic Bojan M, Ostojic Miodrag, Kovacevic-Preradovic Tamara, Kos Ljiljana, Stanetić Kosana, Nikolic Aleksandra, Bojic Milovan, Huber Kurt
机构信息
Department of Cardiology, University Clinical Centre of the Republic of Srpska, Banja Luka, Bosnia and Herzegovina.
Medical Faculty, University of Banja Luka, Bosnia and Herzegovina.
出版信息
Postepy Kardiol Interwencyjnej. 2020 Jun;16(2):153-161. doi: 10.5114/aic.2020.96058. Epub 2020 Jun 23.
INTRODUCTION
Results of currently available trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Current guidelines do not recommend PCI in patients with diabetes and a SYNTAX score ≥ 23.
AIM
To compare all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics.
MATERIAL AND METHODS
The study group comprised consecutive patients with three-vessel CAD and/or unprotected left main CAD (≥ 50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG.
RESULTS
Out of 342 diabetics, 177 patients underwent PCI and 165 patients were referred for CABG. The incidence of all-cause death was different between diabetics treated with PCI or CABG at 4 years (16/177, 9.0% vs. 26/165, 15.8%, respectively, = 0.03). The difference was not evident in non-diabetics (PCI: 41/450, 9.1% vs. CABG: 19/249, 7.6%, = 0.173). In diabetics, there was a higher incidence of all-cause mortality in PCI patients with intermediate-high (≥ 23) SYNTAX scores compared with those with low (0-22) SYNTAX scores (10/56, 17.9% vs. 6/121, 5.0%, respectively, < 0.01). On the other hand, diabetics who underwent CABG showed similar mortality rates irrespective of the SYNTAX scores (SYNTAX 0-22: 3/29, 10.3%; SYNTAX ≥ 23: 23/136, 11.9%, = 0.46). In the subgroup analysis, there was no interaction according to presence or absence of left main CAD ( for interaction = 0.12) as well as according to diabetes status ( for interaction = 0.38), whereas gender and SYNTAX scores were differentiators between PCI and CABG with a for interaction < 0.1.
CONCLUSIONS
Our analysis supports recent evidence that diabetes is not a differentiator between PCI and CABG.
引言
目前可得的试验结果显示，接受经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）的糖尿病患者有着不同的预后。当前指南不建议对糖尿病且SYNTAX评分≥23的患者进行PCI。
目的
比较糖尿病患者复杂冠状动脉疾病（CAD）血运重建术后4年的全因死亡率。
材料与方法
研究组包括连续的患有三支血管CAD和/或无保护左主干CAD（直径狭窄≥50%）且无严重血流动力学不稳定的患者，这些患者在两家机构接受PCI治疗或被转诊进行CABG。
结果
在342名糖尿病患者中，177例接受了PCI，165例被转诊进行CABG。4年时，接受PCI或CABG治疗的糖尿病患者全因死亡发生率不同（分别为16/177，9.0% 对26/165，15.8%，P = 0.03）。在非糖尿病患者中差异不明显（PCI：41/450，9.1% 对CABG：19/249，7.6%，P = 0.173）。在糖尿病患者中，与低（0 - 22）SYNTAX评分的PCI患者相比，中高（≥23）SYNTAX评分的PCI患者全因死亡率更高（分别为10/56，17.9% 对6/121，5.0%，P < 0.01）。另一方面，接受CABG的糖尿病患者无论SYNTAX评分如何，死亡率相似（SYNTAX 0 - 22：3/29，10.3%；SYNTAX≥23：23/136，11.9%，P = 0.46）。在亚组分析中，根据有无左主干CAD（交互作用P = 0.12）以及糖尿病状态（交互作用P = 0.38）没有交互作用，而性别和SYNTAX评分是PCI和CABG之间的区分因素，交互作用P < 0.1。
结论
我们的分析支持最近的证据，即糖尿病不是PCI和CABG之间的区分因素。
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