Stein B, Weintraub W S, Gebhart S P, Cohen-Bernstein C L, Grosswald R, Liberman H A, Douglas J S, Morris D C, King S B
Center For Cardiovascular Epidemiology, Emory University School of Medicine, Atlanta, Ga.
Circulation. 1995 Feb 15;91(4):979-89. doi: 10.1161/01.cir.91.4.979.
Although patients with diabetes mellitus constitute an important segment of the population undergoing coronary angioplasty, the outcome of these patients has not been well characterized.
Data for 1133 diabetic and 9300 nondiabetic patients undergoing elective angioplasty from 1980 to 1990 were analyzed. Diabetics were older and had more cardiovascular comorbidity. Insulin-requiring (IR) diabetics had diabetes for a longer duration and worse renal and ventricular functions compared with non-IR subjects. Angiographic and clinical successes after angioplasty were high and similar in diabetics and nondiabetics. In-hospital major complications were infrequent (3%), with a trend toward higher death or myocardial infarction in IR diabetics. Five-year survival (89% versus 93%) and freedom from infarction (81% versus 89%) were lower, and bypass surgery and additional angioplasty were required more often in diabetics. In diabetics, only 36% survived free of infarction or additional revascularization compared with 53% of nondiabetics, with a marked attrition in the first year after angioplasty, when restenosis is most common. Multivariate correlates of decreased 5-year survival were older age, reduced ejection fraction, history of heart failure, multivessel disease, and diabetes. IR diabetics had worse long-term survival and infarction-free survival than non-IR diabetics.
Coronary angioplasty in diabetics is associated with high success and low complication rates. Although long-term survival is acceptable, diabetics have a higher rate of infarction and a greater need for additional revascularization procedures, probably because of early restenosis and late progression of coronary disease. The most appropriate treatment for these patients remains to be determined.
尽管糖尿病患者是接受冠状动脉血管成形术人群的重要组成部分，但这些患者的治疗结果尚未得到充分描述。
分析了1980年至1990年期间1133例接受择期血管成形术的糖尿病患者和9300例非糖尿病患者的数据。糖尿病患者年龄较大，心血管合并症较多。与非胰岛素依赖型糖尿病患者相比，胰岛素依赖型糖尿病患者糖尿病病程更长，肾功能和心室功能更差。血管成形术后的血管造影和临床成功率较高，糖尿病患者和非糖尿病患者相似。住院期间主要并发症发生率较低（3%），胰岛素依赖型糖尿病患者死亡或心肌梗死的发生率有升高趋势。糖尿病患者的五年生存率（89%对93%）和无梗死生存率（81%对89%）较低，且糖尿病患者更常需要进行搭桥手术和再次血管成形术。在糖尿病患者中，只有36%的患者存活且无梗死或再次血管重建，而非糖尿病患者为53%，血管成形术后第一年的死亡率明显下降，此时再狭窄最为常见。五年生存率降低的多因素相关因素包括年龄较大、射血分数降低、心力衰竭病史、多支血管病变和糖尿病。胰岛素依赖型糖尿病患者的长期生存率和无梗死生存率比非胰岛素依赖型糖尿病患者更差。
糖尿病患者的冠状动脉血管成形术成功率高，并发症发生率低。尽管长期生存率可以接受，但糖尿病患者梗死发生率较高，更需要进行再次血管重建手术，这可能是由于冠状动脉疾病早期再狭窄和晚期进展所致。这些患者最合适的治疗方法仍有待确定。
