摘要
目的评价冠心病合并2型糖尿病患者冠状动脉病变置入药物洗脱支架后的疗效。方法选择我院2004年4月至2005年8月连续接受置入药物洗脱支架(DES)或金属裸支架(BMS)治疗并且进行了冠状动脉造影随访的139例的冠心病合并2型糖尿病患者。所有患者在支架术后6个月后接受冠状动脉造影随访。结果共139例患者(男性114例,女性25例)221处病变完成随访。其中 C 型病变94处(42.5%),完全闭塞病变42处(19.0%),平均每个病变支架长度(26.53±14.72)mm,平均参考血管直径(2.80±0.43)mm。两组患者在性别比例和年龄方面差异无统计学意义。两组在冠心病的危险因素如:高血压病、高脂血症、吸烟等方面差异无统计学意义。两组病变的复杂程度基本相当。DES 组的参考血管直径比 BMS 组小[(2.71±0.41)mm 比(2.98±0.53)mm,P<0.001]。6个月后随访,DES 组的支架内再狭窄率(10.6%比38.6%,P<0.001)和病变内晚期腔径丢失[(0.24±0.56)mm 比(0.91±0.77)mm,P<0.001]明显低于 BMS 组。DES 组的靶病变血管重建率显著低于 BMS 组(8.6%比30.0%,P<0.001)。DES 组有4例晚期支架内血栓。结论本研究显示药物洗脱支架对于冠心病合并2型糖尿病患者冠状动脉病变的介入治疗有着良好的治疗效果,明显优于金属裸支架。
Objective To compare the clinical and angiographic outcome in patients with type-Ⅱ diabetes mellitus undergoing drug-eluting stent （DES） or bare-metal stent （BMS）. Methods A total of 139 consecutive diabetic patients （114 males ） with coronary disease who underwent successful elective pereutaneous coronary intervention with DES （n = 83 with 151 lesions） or BMS （n = 56 with 70 lesions） on native coronary arteries from April 2004 to August 2005 at our institution were included in this study. All patients were treated according to guidelines and coronary angiography was repeated at 6 months post procedure in all patients. Aspirin （300 mg/d） and clopidogrel （75 mg/d） were administered till 6 months after the procedure. Results There were 42. 5% C type by ACC/AHA and 19. 0% total occlusion lesions. The average stent length of each lesion was 26. 53 s 14. 72 mm, and mean reference diameter was 2. 80 s 0. 43 nun. Baseline characteristics were similar between DES and BMS groups except lower mean reference vessel diameter in DES than that of BMS group（2.71 ±0. 41 mm vs. 2.98 ±0. 53 mm,P 〈0. 001 ）. The in atent restenosis rate at 6 months（ 10. 6% vs. 38. 6% , P 〈 0. 001 ） and in-segment late loss （ 0. 24 ±0. 56 nun vs. 0. 91 s0. 77 mm,P 〈0. 001 ）were siginificantly lower in DES group than those of BMS group. The target lesion revascularization （TLR） incidence was also significantly lower in DES group compared to BMS group （8. 6% vs. 30. 0%, P 〈0. 001）. However, 4 late in-stent thrombosis were seen in DES group and none in BMS group of DES （P =0. 148）. Conclusion DES implantation in patients with diabetes mellitus is associated with lower in-stent restenosis and TLR rates compared to BMS implantation 6 months after procedure and attention should be paid on late in-stent thrombosis after DES implantation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2007年第6期523-526,共4页
Chinese Journal of Cardiology
关键词
糖尿病
冠状动脉疾病
支架
血管成形术
经腔
经皮冠状动脉
Diabetes mellitus
Coronary disease
Stents
Angioplasty, transluminal, percutaneous coronary
