Abizaid A, Kornowski R, Mintz G S, Hong M K, Abizaid A S, Mehran R, Pichard A D, Kent K M, Satler L F, Wu H, Popma J J, Leon M B
Cardiac Catheterization Laboratories, The Washington Hospital Center, DC, USA.
J Am Coll Cardiol. 1998 Sep;32(3):584-9. doi: 10.1016/s0735-1097(98)00286-1.
We compared the clinical outcomes following coronary stent implantation in insulin-treated diabetes mellitus (IDDM), non-IDDM patients, and nondiabetic patients.
Diabetic patients have increased restenosis and late morbidity following balloon angioplasty. The impact of diabetes mellitus (DM), especially IDDM, on in-stent restenosis is not known.
We studied 954 consecutive patients with native coronary artery lesions treated with elective Palmaz-Schatz stents implantation using conventional coronary angiographic and intravascular ultrasound methodology. Procedural success, major in-hospital complications, and 1-year clinical outcome were compared according to the diabetic status. RESULTS. In-hospital mortality was 2% in IDDM, significantly higher (p <0.02) compared with non-IDDM (0%) and nondiabetics (0.3%). Stent thrombosis did not differ among groups (0.9% in IDDM vs. 0% in non-IDDM and 0% in nondiabetics, p >0.1). During follow-up, target lesion revascularization (TLR) was 28% in IDDM, significantly higher (p <0.05) compared with non-IDDM (17.6%) and nondiabetics (16.3%). Late cardiac event-free survival (including death, myocardial infarction [MI], and any coronary revascularization procedure) was significantly lower (p=0.0004) in IDDM (60%) compared with non-IDDM (70%) and nondiabetic patients (76%). By multivariate analysis, IDDM was an independent predictor for any late cardiac event (OR=2.05, p=0.0002) in general and TLR (odds ratio=2.51, p=0.0001) in particular. CONCLUSIONS. In a large consecutive series of patients treated by elective stent implantation, IDDM patients were at higher risk for in-hospital mortality and subsequent TLR and, as a result, had a significantly lower cardiac event-free survival rate. On the other hand, acute and long-term procedural outcome was found to be similar for non-IDDM compared with nondiabetic patients.
我们比较了接受冠状动脉支架植入术的胰岛素治疗的糖尿病（IDDM）患者、非IDDM患者和非糖尿病患者的临床结局。
糖尿病患者在球囊血管成形术后再狭窄和晚期发病率增加。糖尿病（DM），尤其是IDDM，对支架内再狭窄的影响尚不清楚。
我们使用传统冠状动脉造影和血管内超声方法研究了954例连续的原发性冠状动脉病变患者，这些患者接受了择期Palmaz-Schatz支架植入术。根据糖尿病状态比较手术成功率、主要院内并发症和1年临床结局。结果。IDDM患者的院内死亡率为2%，与非IDDM患者（0%）和非糖尿病患者（0.3%）相比显著更高（p<0.02）。各组间支架血栓形成无差异（IDDM患者为0.9%，非IDDM患者和非糖尿病患者均为0%，p>0.1）。在随访期间，IDDM患者的靶病变血管重建术（TLR）为28%，与非IDDM患者（17.6%）和非糖尿病患者（16.3%）相比显著更高（p<0.05）。IDDM患者的晚期无心脏事件生存率（包括死亡、心肌梗死[MI]和任何冠状动脉血管重建术）（60%）显著低于非IDDM患者（70%）和非糖尿病患者（76%）（p=0.0004）。通过多变量分析，IDDM总体上是任何晚期心脏事件的独立预测因素（OR=2.05，p=0.0002），尤其是TLR（优势比=2.51，p=0.0001）。结论。在一大组接受择期支架植入术治疗的连续患者中，IDDM患者院内死亡和随后TLR的风险更高，因此无心脏事件生存率显著更低。另一方面，发现非IDDM患者与非糖尿病患者相比，急性和长期手术结局相似。
