Van Belle E, Bauters C, Hubert E, Bodart J C, Abolmaali K, Meurice T, McFadden E P, Lablanche J M, Bertrand M E
Department of Cardiology, University of Lille, France.
Circulation. 1997 Sep 2;96(5):1454-60. doi: 10.1161/01.cir.96.5.1454.
Diabetes is a major risk factor for restenosis after coronary balloon angioplasty. Recent studies have shown that coronary stenting significantly reduces restenosis compared with balloon angioplasty alone. However, limited information is available on the effect of coronary stenting in diabetic patients.
We designed this study to analyze the effect of diabetes on restenosis in patients treated with either balloon angioplasty or coronary stenting who were enrolled in a 6-month angiographic follow-up program. Three hundred consecutive patients, 19% of whom were diabetics, who underwent coronary stent implantation during a single-vessel procedure on native coronary vessels and who had 6-month angiographic follow-up constituted the study group (stent group). Three hundred consecutive patients who underwent 6-month angiographic follow-up after single-vessel conventional balloon angioplasty served as control patients (balloon group). Preprocedural, postprocedural, and follow-up angiograms were analyzed with quantitative angiography. In the balloon group, the restenosis rate was almost twofold higher in diabetic than in nondiabetic patients (63% versus 36%; P=.0002) owing to both a greater late loss (0.79+/-0.70 versus 0.41+/-0.61 mm, respectively; P<.0001) and a higher rate of late vessel occlusion (14% versus 3%, respectively; P<.001). In the stent group, restenosis rates were similar in diabetics and nondiabetics (25% versus 27%, respectively). Furthermore, in the stent group, late loss (0.77+/-0.65 versus 0.79+/-0.57 mm, respectively) and the rate of late vessel occlusion (2% versus 1%, respectively) did not differ significantly between diabetic and nondiabetic patients.
Although diabetics have increased rates of restenosis and late vessel occlusion after simple balloon angioplasty, they have the same improved outcome with coronary stenting that has been documented in nondiabetic patients.
糖尿病是冠状动脉球囊血管成形术后再狭窄的主要危险因素。近期研究表明，与单纯球囊血管成形术相比，冠状动脉支架置入术能显著降低再狭窄率。然而，关于冠状动脉支架置入术对糖尿病患者影响的信息有限。
我们设计本研究以分析糖尿病对接受球囊血管成形术或冠状动脉支架置入术且参加了为期6个月血管造影随访项目患者再狭窄的影响。连续300例患者构成研究组（支架组），这些患者在单支冠状动脉血管的单一手术中接受了冠状动脉支架植入术，且有6个月的血管造影随访，其中19%为糖尿病患者。连续300例在单支冠状动脉进行传统球囊血管成形术后接受6个月血管造影随访的患者作为对照患者（球囊组）。术前、术后及随访血管造影采用定量血管造影分析。在球囊组，糖尿病患者的再狭窄率几乎是非糖尿病患者的两倍（分别为63%和36%；P = 0.0002），这是由于晚期管腔丢失更大（分别为0.79±0.70 mm和0.41±0.61 mm；P < 0.0001）以及晚期血管闭塞率更高（分别为14%和3%；P < 0.001）。在支架组，糖尿病患者和非糖尿病患者的再狭窄率相似（分别为25%和27%）。此外，在支架组，糖尿病患者和非糖尿病患者的晚期管腔丢失（分别为0.77±0.65 mm和0.79±0.57 mm）及晚期血管闭塞率（分别为2%和1%）差异无统计学意义。
尽管糖尿病患者在单纯球囊血管成形术后再狭窄率和晚期血管闭塞率增加，但他们在冠状动脉支架置入术后的预后改善情况与非糖尿病患者相同。
