摘要
目的:比较冠状动脉慢性完全闭塞(chronic total occlusion,CTO)合并糖尿病的患者采用不同血运重建策略后的不良事件发生率以及预后影响因素。方法:回顾性分析2017年11月至2019年12月,于首都医科大学附属北京安贞医院入院,行冠状动脉造影检查并诊断为CTO,同时合并糖尿病的530例患者的临床资料及影像资料。根据血运重建方式将患者分为经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)组和冠状动脉旁路移植术(coronary artery bypass grafting,CABG)组。利用Logistic回归分析选择不同血运重建术式的CTO合并糖尿病患者临床特征,利用Cox回归分析筛选与不良心血管事件相关的临床危险因素,以及评估TG-葡萄糖(triglyceride-glucose,Ty G)指数与不良心血管事件的相关性。结果:经过中位21.6(16.0,29.2)个月的随访,共有78例合并糖尿病的CTO患者发生了复合心血管事件,PCI组和CABG组分别有66(14.8%)例和12(14.1%)例患者发生了复合心血管事件。CABG组患者的全因死亡率显著高于PCI组(4.7%vs.0.7%,P=0.015)。Logistic回归分析显示LVEF>50%、既往有PCI史、舒张压更高,以及入院诊断为不稳定型心绞痛的患者更多地被施以PCI术;而对年龄较大、心肌肌钙蛋白I和HbA1c水平较高、冠状动脉病变支数较多、合并左主干病变、吸烟,以及有脑血管病史的患者更多地进行了CABG术。通过Cox比例风险回归分析发现,与复合心血管事件相关的危险因素有诊断为急性心肌梗死、3支病变、HbA1c水平升高;保护因素有LVEF>50%和口服降糖药治疗。TyG指数与复合心血管事件显著相关(HR=1.655,P<0.05)。结论:针对具有不同临床特征的CTO合并糖尿病患者应制定相应的血运重建策略,反应胰岛素抵抗程度的TyG指数与血运重建后的复合心血管事件显著相关。
Objective:To compare the incidence of adverse events and prognostic factors in patients with chronic total occlusion of coronary artery(CTO)and diabetes.Methods:The clinical data and imaging data of 530 CTO patients with diabetes who were admitted to Beijing Anzhen Hospital affiliated to Capital Medical University from November 2017 to December 2019 were retrospectively analyzed.The patients were divided into percutaneous coronary intervention(PCI)group and coronary artery bypass grafting(CABG)group.Logistic regression analysis was used to analyze the clinical characteristics of CTO patients with diabetes who chose different revascularization strategy.Cox regression analysis was used to screen clinical risk factors of adverse cardiovascular events,and to evaluate the correlation between triglyceride glucose index and adverse cardiovascular events.Results:After a median follow-up of 21.6(16.0,29.2)months,78 CTO patients with diabetes had complex cardiovascular events.66(14.8%)patients in PCI group and 12(14.1%)patients in CABG group.The all-cause mortality rate of patients in the CABG group was significantly higher than that in the PCI group(4.7%vs.0.7%,P=0.015).Logistic regression analysis showed that patients with left ventricular ejection fraction greater than 50%,previous PCI history,higher diastolic blood pressure,and unstable angina on admission were more likely to be treated with PCI.However,CABG was performed more frequently in older patients with higher levels of myocardial troponin I and glycated hemoglobin,more coronary artery lesions,left main artery lesions,smoking,and cerebrovascular diseases.Cox proportional hazard regression analysis showed that the risk factors associated with complex cardiovascular events were acute myocardial infarction,triple vessel disease,and elevated glycated hemoglobin levels;the protective factors were left ventricular ejection fraction greater than 50%and oral hypoglycemic drugs.The triglyceride glucose index(TyG)was significantly correlated with complex cardiovascular ev
作者
温海初
袁梦
杜杰
WEN Haichu;YUAN Meng;DU Jie(Cardiovascular Biology Laboratory,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)
出处
《心肺血管病杂志》
CAS
2023年第12期1199-1205,共7页
Journal of Cardiovascular and Pulmonary Diseases
