Zhao Xiaoxiao, Lan Jun, Yu Xiaoping, Zhou Jinying, Tan Yu, Sheng Zhaoxue, Li Jiannan, Wang Ying, Chen Runzhen, Liu Chen, Zhou Peng, Chen Yi, Song Li, Zhao Hanjun, Yan Hongbing
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China.
Department of Cardiovascular Medicine and Dongguan Cardiovascular Institute, Songshan Lake (SSL) Central Hospital of Dongguan City, The Third People's Hospital of Dongguan City, Affiliated Dongguan Shilong People's Hospital of Southern Medical University, Dongguan, China.
Front Cardiovasc Med. 2021 Jun 22;8:653467. doi: 10.3389/fcvm.2021.653467. eCollection 2021.
This study compared differences in the risk factors and clinical outcomes of primary percutaneous coronary intervention (PCI) in type 2 diabetes mellitus (DM) and non-DM patients with lesions (DNLs) and late or very late stent thrombosis (LST/VLST). We used angiography to screen 4,151 patients with acute coronary syndrome for DNL and LST/VLST lesions. Overall, 3,941 patients were included in the analysis and were allocated to the DM ( = 1,286) or non-DM ( = 2,665) group at admission. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), defined as death, myocardial infarction, revascularization, and ischemic stroke, within a median follow-up period of 698 days. In the group with a total white blood cell count >10 × 10/L ( = 0.004), a neutral granular cell count >7 × 10/L ( = 0.030), and neutrophil-lymphocyte ratio >1.5 ( = 0.041), revascularization was better for DNL than for LST/VLST lesions. Among DM patients with DNLs, each unit increase in age was associated with a 53.6% increase in the risk of MACEs [hazard ratio (HR): 1.536, 95% confidence interval (CI), 1.300-1.815, < 0.0001]. Older age (≥65 years) was associated with a significantly greater risk of MACEs ( < 0.0001). Furthermore, each standard deviation (SD) increase in the level of peak white blood cell counts was associated with a 50.1% increase in the risk of MACEs (HR, 1.501; 95% CI, 1.208-1.864; = 0.0002). When stratifying the DM population with DNLs according to the D-dimer baseline and peak levels <0.5 vs. ≥0.5 mg/L, the high D-dimer group at baseline had a 2.066-fold higher risk of MACEs ( < 0.0001), and the high peak level D-dimer group had a 1.877-fold higher risk of MACEs ( = 0.001) compared to the low-level groups. Among DM patients with LST/VLST, each unit increase in age was associated with a 75.9% increase in the risk of MACEs (HR: 1.759, 95% CI, 1.052-2.940, = 0.032). Furthermore, for each SD increase in the peak D-dimer level, the risk of MACEs increased by 59.7% (HR, 1.597; 95% CI, 1.110-2.295; = 0.041). Following successful primary PCI, the measurement of baseline and peak D-dimer values may help identify individuals at high cardiovascular risk. This suggests a potential benefit of lowering D-dimer levels among T2DM patients with DNL. Furthermore, age and the peak D-dimer values may facilitate the risk stratification of T2DM patients with LST/VLST.
本研究比较了2型糖尿病（DM）患者与非DM患者在原发性经皮冠状动脉介入治疗（PCI）中，病变（DNL）以及晚期或极晚期支架血栓形成（LST/VLST）的危险因素和临床结局的差异。我们使用血管造影术对4151例急性冠状动脉综合征患者进行DNL和LST/VLST病变筛查。总体而言，3941例患者纳入分析，并在入院时分为DM组（n = 1286）或非DM组（n = 2665）。主要终点是在698天的中位随访期内，主要不良心血管事件（MACE）的复合终点，定义为死亡、心肌梗死、血运重建和缺血性卒中。在白细胞总数>10×10⁹/L（P = 0.004）、中性粒细胞计数>7×10⁹/L（P = 0.030）和中性粒细胞-淋巴细胞比值>1.5（P = 0.041）的组中，DNL病变的血运重建效果优于LST/VLST病变。在患有DNL的DM患者中，年龄每增加一个单位，MACE风险增加53.6%[风险比（HR）：1.536，95%置信区间（CI），1.300 - 1.815，P < 0.0001]。年龄较大（≥65岁）与MACE风险显著增加相关（P < 0.0001）。此外，白细胞峰值水平每增加一个标准差（SD），MACE风险增加50.1%（HR，1.501；95%CI，1.208 - 1.864；P = 0.0002）。当根据D - 二聚体基线和峰值水平<0.5与≥0.5mg/L对患有DNL的DM人群进行分层时，基线D - 二聚体高水平组的MACE风险比低水平组高2.066倍（P < 0.0001），峰值D - 二聚体高水平组的MACE风险比低水平组高1.877倍（P = 0.001）。在患有LST/VLST的DM患者中，年龄每增加一个单位，MACE风险增加75.9%（HR：1.759，95%CI，1.052 - 2.940，P = 0.032）。此外，D - 二聚体峰值水平每增加一个SD，MACE风险增加59.7%（HR，1.597；95%CI，1.110 - 2.295；P = 0.041）。在原发性PCI成功后，测量基线和峰值D - 二聚体值可能有助于识别心血管高风险个体。这表明降低患有DNL的2型糖尿病患者的D -二聚体水平可能有益。此外，年龄和D - 二聚体峰值水平可能有助于对患有LST/VLST的2型糖尿病患者进行风险分层。
