Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery Trial (OAT).
Percutaneous revascularization and long term clinical outcomes of diabetic patients randomized in the Occluded Artery Trial (OAT).
复制标题
动脉闭塞试验 (OAT) 中随机分配的糖尿病患者的经皮血运重建和长期临床结果。
DOI：
10.1016/j.ijcard.2013.02.004
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发表时间：
2013
影响因子：
3.5
通讯作者：
OAT
中科院分区：
文献类型：
--
作者：
Overgaard,ChristopherB;Džavík,Vladimír;Buller,ChristopherE;Liu,Li;Banasiak,Waldemar;Devlin,Gerard;Maggioni,AldoP;Leor,Jonathan;Burton,JefferyR;Reis,Gilmar;Ruzyllo,Witold;Forman,SandraA;Lamas,GervasioA;Hochman,JudithS;OAT
背景：稳定的高风险患者在心肌梗死（MI） 24小时后，对持续完全闭塞的梗死相关动脉（IRA）进行经皮冠状动脉介入治疗（PCI）并不能减少死亡、再梗死或心力衰竭的发生。糖尿病患者发生心血管事件的风险较高；我们检查了PCI和最佳药物治疗（MED）的总体结果。方法：在动脉闭塞试验（OAT）中，454例（20.6%）糖尿病患者（随机）接受PCI或MED治疗的长期（7年）结局以死亡、再发心肌梗塞或纽约心脏协会IV级心力衰竭为复合主要终点进行评估。对糖尿病患者和非糖尿病患者进行比较，并根据治疗策略评估结果。结果糖尿病患者7年累积原发事件发生率为35.0%，非糖尿病患者为19.4% （p < 0.001）。多变量分析显示糖尿病是主要结局、致死性或非致死性复发性心肌梗死、IV级心力衰竭（HF）和死亡的独立预测因子（p < 0.01）。糖尿病患者PCI组7年累积原发性事件发生率为35.3%，药物治疗组为34.5% (p = 0.19)，非糖尿病患者PCI组为19.3%，药物治疗组为19.5% （p = 0.60）。结论：尽管糖尿病患者的总体风险较高，但PCI并没有改善该亚人群的临床结果，并且在心肌梗死后亚急性期具有梗死相关动脉完全闭塞的其他稳定患者中不适用。
BackgroundPercutaneous coronary intervention (PCI) of a persistently totally occluded infarct-related artery (IRA) in stable high-risk patients > 24 h after myocardial infarction (MI) does not reduce the occurrence of death, re-infarction, or heart failure. Diabetic patients are at higher risk for cardiovascular events; we examined their outcomes overall with PCI and optimal medical therapy alone (MED).MethodsThe long-term (7-year) outcomes of 454 diabetic patients (20.6%) randomized to PCI or MED in the Occluded Artery Trial (OAT) were assessed for the composite primary endpoint of death, re-MI, or New York Heart Association class IV heart failure. Diabetics and non-diabetics were compared and outcomes assessed by treatment strategy.ResultsThe 7-year cumulative primary event rate for diabetic patients was 35.0% vs. 19.4% in the non-diabetic cohort (p < 0.001). Multivariable analyses revealed diabetes to be an independent predictor (p < 0.01) for the primary outcome, fatal or nonfatal recurrent MI, Class IV Heart Failure (HF), and death. The 7-year cumulative primary event rates were 35.3% in the PCI group vs. 34.5% in the medical therapy group in diabetic patients (p = 0.19) and 19.3% in the PCI group vs. 19.5% in the medical therapy group in patients without diabetes (p = 0.60).ConclusionsDespite the higher overall risk conferred by the presence of diabetes, PCI did not improve clinical outcomes in this subpopulation, and is not indicated in otherwise stable patients with a totally occluded infarct-related artery in the sub-acute phase after MI.