Optimal cardiac strategy based on the history of myocardial infarction in type 2 diabetic patients with coronary artery disease.
Optimal cardiac strategy based on the history of myocardial infarction in type 2 diabetic patients with coronary artery disease.
复制标题
基于 2 型糖尿病合并冠状动脉疾病患者心肌梗塞病史的最佳心脏策略。
DOI：
10.1038/s41598-019-39857-0
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发表时间：
2019
影响因子：
4.6
通讯作者：
Tetsuro Tsujimoto and Hiroshi Kajio
中科院分区：
文献类型：
--
作者：
Tsujimoto Tetsuro;Kajio Hiroshi;Tetsuro Tsujimoto and Hiroshi Kajio
本研究的目的是评估心脏治疗策略与2型糖尿病合并冠心病(CAD)患者心脏事件风险之间的关系。采用BARI 2D试验数据，用Cox比例风险模型计算接受早期血管重建术或强化药物治疗的患者发生主要心脏事件的风险比(HR)。无 患者(n=1,557)和有心肌梗死患者(n= ，736例)分别进行分析。在非心肌梗死患者中，经皮冠状动脉介入治疗组和强化内科治疗组发生主要心脏事件的风险相似，而冠状动脉旁路移植组显著低于内科强化治疗组(HR：0.48，95%可信区间[95%CI]：0.3~0.76，P= 0.002)。相反，在心肌梗死患者中，早期血运重建组发生主要心脏事件的风险显著高于强化药物治疗组(HR：1.4 7，95%CI：1.0 3~2.11，P= 0.0 3)。在合并冠心病的2型糖尿病患者中，早期血管重建术的益处仅见于那些没有心肌梗死病史的患者。对于既往有心肌梗死史的患者，强化内科治疗发挥了更大的益处。
The aim of this study was to evaluate the association between the cardiac treatment strategy and cardiac event risk in type 2 diabetic patients with coronary artery disease (CAD) based on the history of myocardial infarction. Using Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial data, a Cox proportional hazard model was used for calculating hazard ratios (HRs) for major cardiac events in patients receiving early revascularization or intensive medical therapy. Patients without (n= 1,557) and with myocardial infarction (n= 736) were separately analyzed. In patients without myocardial infarction, risk of major cardiac events was similar for percutaneous coronary intervention and intensive medical therapy groups, whereas it was significantly lower in the coronary artery bypass grafting group than in the intensive medical therapy group (HR: 0.48, 95% confidence interval [95%CI]: 0.30–0.76,P= 0.002). Conversely, in patients with myocardial infarction, risk of major cardiac events was significantly higher in the early revascularization group than in the intensive medical therapy group (HR: 1.47, 95%CI: 1.03–2.11,P= 0.03). In type 2 diabetic patients with CAD, benefits of early revascularization were observed only in those without previous myocardial infarction. For patients with previous myocardial infarction, intensive medical therapy exerted superior benefits.