Fujita Takanari, Takeda Teruki, Tsujino Yasushi, Yamaji Masayuki, Sakaguchi Tomoko, Maeda Keiko, Mabuchi Hiroshi, Murakami Tomoyuki, Morimoto Takeshi, Kimura Takeshi
Department of Cardiovascular Medicine, Koto Memorial Hospital Higashiomi Japan.
Department of Clinical Epidemiology, Hyogo College of Medicine Nishinomiya Japan.
Circ Rep. 2020 Aug 4;2(9):479-489. doi: 10.1253/circrep.CR-20-0065.
Few studies have investigated the importance of glycemic control in patients with diabetes mellitus (DM) for reducing the incidence of late target lesion revascularization (TLR) after implantation of new-generation drug-eluting stents (DES). We retrospectively identified 1,568 patients who underwent new-generation DES implantation. Patients were divided into 3 groups based on diabetic status and glycemic control 1 year after the procedure: those without DM (non-DM group; n=1,058) and those with DM at follow-up with either good (HbA1c <7%; n=328) or poor (HbA1c ≥7%; n=182) control. The cumulative 5-year incidence of clinically driven late TLR after the index procedure was significantly higher in DM with poor control at follow-up than in those with good control at follow-up or non-DM (14%, 4.8%, and 2.9%, respectively; P<0.0001). Multivariate analysis revealed that poor control at follow-up was significantly associated with a higher risk of clinically driven late TLR compared with the non-DM group (hazard ratio [HR] 4.58, 95% confidence interval [CI] 2.50-8.16, P<0.0001). However, good control at follow-up group was not associated with a higher risk of clinically driven late TLR compared with the non-DM group (HR 1.35, 95% CI 0.68-2.56, P=0.38). DM patients with poor glycemic control at follow-up had a significantly higher risk of clinically driven late TLR than non-DM patients.
很少有研究调查糖尿病（DM）患者血糖控制对于降低新一代药物洗脱支架（DES）植入后晚期靶病变血管重建（TLR）发生率的重要性。我们回顾性地确定了1568例行新一代DES植入术的患者。根据术后1年的糖尿病状态和血糖控制情况，将患者分为3组：无DM者（非DM组；n = 1058）以及随访时患有DM且血糖控制良好（糖化血红蛋白<7%；n = 328）或控制不佳（糖化血红蛋白≥7%；n = 182）者。随访时血糖控制不佳的DM患者在索引手术后临床驱动的晚期TLR累积5年发生率显著高于随访时血糖控制良好者或非DM患者（分别为14%、4.8%和2.9%；P<0.0001）。多变量分析显示，与非DM组相比，随访时控制不佳与临床驱动的晚期TLR风险较高显著相关（风险比[HR] 4.58，95%置信区间[CI] 2.50 - 8.16，P<0.0001）。然而，与非DM组相比，随访时控制良好组与临床驱动的晚期TLR风险较高无关（HR 1.35，95% CI 0.68 - 2.56，P = 0.38）。随访时血糖控制不佳的DM患者发生临床驱动的晚期TLR的风险显著高于非DM患者。
