Henry P, Makowski S, Richard P, Beverelli F, Casanova S, Louali A, Boughalem K, Battaglia S, Guize L, Guermonprez J L
Department of Cardiology, Hôpital Broussais, Paris, France.
Am Heart J. 1997 Dec;134(6):1037-43. doi: 10.1016/s0002-8703(97)70023-1.
Persons with diabetes are at higher risk for myocardial infarction and sudden death than are persons without diabetes. It has been demonstrated that the artery that occludes during acute myocardial infarction generally had less than 75% stenosis on a previous angiogram. The extent of coronary artery stenosis was analyzed for 820 consecutively examined patients who underwent coronary angiography at our institution. The patients were categorized according to the presence or absence of diabetes mellitus. The severity of stenosis was taken into consideration. Patients with diabetes had moderate (50% to 75% narrowing) stenosis much more frequently than patients without diabetes (50.6 versus 30.3%, p < 0.001). Moreover diabetes mellitus was an independent risk factor for moderate stenosis. The lesions were more frequently located on distal arteries, more frequently had a pattern of three-vessel disease, and had a trend toward more diffuse disease than described 25 years ago. This greater amount of moderate stenosis may be considered a substrate for future acute plaque rupture. It may explain the high prevalence of acute myocardial infarction and sudden death among patients with diabetes without an increase in the incidence of angina pectoris.
糖尿病患者比非糖尿病患者发生心肌梗死和猝死的风险更高。已经证明，急性心肌梗死期间闭塞的动脉在先前的血管造影中通常狭窄程度小于75%。对在我们机构连续接受冠状动脉造影检查的820例患者的冠状动脉狭窄程度进行了分析。根据是否患有糖尿病对患者进行分类。考虑了狭窄的严重程度。糖尿病患者中度（狭窄50%至75%）狭窄的发生率比非糖尿病患者高得多（50.6%对30.3%，p<0.001）。此外，糖尿病是中度狭窄的独立危险因素。与25年前相比，病变更频繁地位于远端动脉，更频繁地呈现三支血管病变模式，并且有更弥漫性疾病的趋势。这种更大量的中度狭窄可能被认为是未来急性斑块破裂的基础。这可能解释了糖尿病患者中心肌梗死和猝死的高发生率，而心绞痛的发生率并未增加。
