O'Keefe J H, Blackstone E H, Sergeant P, McCallister B D
Cardiovascular and Cardiothoracic Research Center, Mid America Heart Institute, Kansas City, Missouri, USA.
Eur Heart J. 1998 Nov;19(11):1696-703. doi: 10.1053/euhj.1998.1153.
Some recent studies have reported-superior outcomes for diabetic patients following coronary bypass surgery compared with coronary angioplasty. However, the available data are conflicting, are based on relatively small numbers of diabetic patients, and have limited duration of follow-up. The aims of this study were to compare risk adjusted long-term survival in diabetic patients following first-time revascularization via either coronary bypass surgery or coronary angioplasty; and, to identify variables independently associated with mortality.
This was a two centre database project involving 15809 patients undergoing either coronary angioplasty or coronary bypass surgery as their initial revascularization procedure. Diabetes was present in 1938 (12%). Mean follow-up was 4.6+/-2.7 years for angioplasty and 6.6+/-4.3 years surgery diabetic patients. Multivariable time-related analyses in the hazard function domain for death were performed. Overall ten-year survival for pharmacologically treated diabetics was better after coronary bypass surgery (60%) than angioplasty (46%, <0.0001). However, the risk-adjusted survival advantage conferred by bypass surgery over angioplasty was strongest for patients receiving oral agents for diabetic control (75% vs 62%) and less impressive for diet (84% vs 81%) and insulin-treated diabetics (63% vs 64%). The major factors independently associated with worse outcome after angioplasty were incomplete revascularization, and the use of a sulfonylurea agent. The use of the left internal mammary graft improved survival in surgical patients.
In general, diabetic patients had better long-term survival after bypass surgery than angioplasty. Incomplete revascularization and sulfonylurea therapy worsened outcome after angioplasty, and use of the left internal mammary improved outcome after bypass surgery.
近期一些研究报告称，与冠状动脉血管成形术相比，糖尿病患者冠状动脉搭桥手术后的预后更佳。然而，现有数据相互矛盾，且基于相对较少的糖尿病患者数量，随访时间也有限。本研究的目的是比较首次通过冠状动脉搭桥手术或冠状动脉血管成形术进行血运重建的糖尿病患者经风险调整后的长期生存率；并确定与死亡率独立相关的变量。
这是一个两中心数据库项目，涉及15809例接受冠状动脉血管成形术或冠状动脉搭桥手术作为初始血运重建手术的患者。其中1938例（12%）患有糖尿病。血管成形术糖尿病患者的平均随访时间为4.6±2.7年，手术糖尿病患者为6.6±4.3年。在死亡风险函数领域进行了多变量时间相关分析。药物治疗的糖尿病患者冠状动脉搭桥手术后的总体十年生存率（60%）高于血管成形术（46%，<0.0001）。然而，搭桥手术相对于血管成形术在风险调整后的生存优势，对于接受口服降糖药治疗的患者最为显著（75%对62%），对于饮食控制患者（84%对81%）和胰岛素治疗的糖尿病患者（63%对64%）则不那么明显。血管成形术后与预后较差独立相关的主要因素是血运重建不完全和使用磺脲类药物。使用左乳内动脉移植物可提高手术患者的生存率。
总体而言，糖尿病患者搭桥手术后的长期生存率高于血管成形术。血管成形术后血运重建不完全和磺脲类药物治疗会使预后恶化，而搭桥手术后使用左乳内动脉可改善预后。
