摘要
目的:评价冠心病合并糖尿病患者成功置入药物洗脱支架(DES)和裸金属支架(BMS)2年后的有效性和安全性。方法:本研究入选了2004-04至2006-10在我院行择期支架置入术的冠心病合并糖尿病患者1565例。入选患者分为DES组(n=1317)和BMS组(n=248例)。随访资料包括术后30天、1年和2年的死亡、心肌梗死、血栓、靶病变血运重建和靶血管血运重建。本研究比较了DES和BMS两组间各种临床事件累积发生率的差异,同时通过倾向性评分调整后的Cox比例风险模型比较两组术后2年的临床随访结果。结果:DES和BMS两组患者术后2年出现学术研究联合会(ARC)定义的支架内血栓形成率差异无统计学意义,但DES组术后30天明确血栓形成率显著低于BMS组(0.08%比0.81%,P=0.016)。术后2年与BMS相比,DES组靶病变血运重建率[3.88%比10.89%;风险比0.159(95%可信区间:0.151～0.444),P<0.0001]和靶血管血运重建率[5.48%比11.69%;风险比0.383(95%可信区间:0.232～0.633),P<0.0001]的风险均显著降低,差异均有统计学意义。两组间全因死亡率、心肌梗死发生率及全因死亡/心肌梗死发生率差异均无统计学意义。结论:对于冠心病合并糖尿病患者而言,与置入BMS相比,使用DES可以显著降低靶病变血运重建率和靶血管血运重建率,但是全因死亡率、心肌梗死发生率和血栓形成率的差异均无统计学意义。
To compare the long-term clinical outcomes after percuteneous coronary intervention（PCI） with drug-eluting stent （DES） or bare metal stent（BMS） implantation in coronary artery disease （CAD） patients combined with diabetes mellitus（ DM ）. Methods： A total of 1565 consecutive CAD patients combined with DM who underwent elective stenting from April 2004 to October 2006 in our hospital were studied. The patients were divided into DES group, n =1 317 and BMS group, n =248. According to Academic Research Consortium（ARC） standard, the follow-up results included death, myocardioinfaretion （MI）, thrombus, target lesion revaseularization （TLR） and target vessel revascularization （TVR） at 30 days,12 months and 24 months after PCI. We calculated and compared all the unadjusted cumulative frequencies of the various adverse events in both DES and BMS groups. Cox＇ s proportional-hazards models adjusted with the propensity score were used to assess the relative risks of clinical outcomes at 24 months after PCI. Results ： ARC defined stentt thrombosis at 24 months after PCI were no difference in two groups, while definite thrombosis for- mation rate in BMS group was lower than that in BEM group （0. 08% vs. 0. 81% ,P =0. 016） at 30 days after PCL Patients trea- ted with DES showed significant lower risk of TLR [ 3.88 % vs. 10. 89 % ; HR,0. 159 （95 % CI ： 0. 151-0. 444）, P 〈 0. 0001 ） andTVR [5.48% vs. 11.69% ; HR,0. 383 （95% CI：0. 232-0. 633） ,P 〈0. 00013 at 24 months. No difference in all-cause mortality, MI and all-cause mortality/MI. Conclusion： In real-world practice,implantation of DES showed the lower risks of TLR and TVR at 24 months for CAD patients combined with DM. There was no significant difference on all-cause mortality, MI and thrombosis between DES and BMS implantation in those patients.
出处
《中国循环杂志》
CSCD
北大核心
2010年第1期7-10,共4页
Chinese Circulation Journal
关键词
糖尿病
药物洗脱支架
裸金属支架
临床疗效
Diabetes meuitus
drug-eluting stent
bare metal stent
clinical outcome
