Outcomes in patients with diabetes Mellitus undergoing percutaneous coronary intervention in the current era - A report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial
Outcomes in patients with diabetes Mellitus undergoing percutaneous coronary intervention in the current era - A report from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) Trial
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DOI：
10.1161/01.cir.0000109693.64957.20
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发表时间：
2004-02-03
期刊：
影响因子：
37.8
通讯作者：
Holmes, DR
中科院分区：
文献类型：
--
作者：
Mathew, V;Gersh, BJ;Holmes, DR
背景-糖尿病预示着接受经皮冠状动脉介入治疗（PCI）患者的不良预后。当前临床实践（支架、IIb/IIIa拮抗剂）的改进是否导致这些结果的实质性改善仍然是一个问题。本研究的目的是确定糖尿病对9个月的患者接受PCI治疗的结果在当前时代的影响。方法和结果-11 482例患者参加了预防再狭窄曲尼司特及其结果（PRESTO）试验分层根据存在（n = 2694）或不存在（n = 8798）糖尿病。糖尿病患者年龄偏大;与非糖尿病患者相比，糖尿病患者更可能是女性;充血性心力衰竭、高血压、既往CABG和不稳定型心绞痛的比例更高;体重指数更高，射血分数更低（所有比较均P <0.01）。两组间多支血管病变的程度相似。美国心脏病学会/美国心脏协会C型病变在糖尿病患者中更常见（17%比15%，P <0.01）。两组的血管造影和手术成功率以及院内事件相似。死亡、心肌梗死或靶血管血运重建（TVR）的主要终点作为首次PCI后9个月内至首次事件的时间进行分析。在调整某些基线特征后，糖尿病与9个月时的死亡独立相关（相对危险度[RR]，1.87; 95%CI，1.31 - 2.68，P <0.01），TVR的可能性增加（RR，1.27; 95%CI，1.14~1.42，P <0.01），以及死亡/心肌梗死/TVR复合终点（RR，1.26; 95%CI，1.13 - 1.40，P <0.01）结论--尽管介入技术有进步，糖尿病仍然是PCI术后中期不良事件的重要独立预测因子。
Background - Diabetes portends an adverse prognosis in patients undergoing percutaneous coronary intervention (PCI). Whether improvements in current clinical practice (stents, IIb/IIIa antagonists) have resulted in substantial improvement of these outcomes remains an issue. The aim of this study was to determine the influence of diabetes on 9-month outcomes of patients undergoing PCI in the current era.Methods and Results - The 11 482 patients enrolled in the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO) Trial were stratified according to the presence ( n = 2694) or absence ( n = 8798) of diabetes. Diabetic patients were older; were more likely to be female; had a higher proportion of congestive failure, hypertension, prior CABG, and unstable angina; and had higher body mass index and lower ejection fraction than nondiabetic patients ( P < 0.01 for all comparisons). The degree of multivessel disease was similar between the two groups. American College of Cardiology/American Heart Association type C lesions were more common in diabetic patients (17% versus 15%, P < 0.01). Angiographic and procedural success rates and in-hospital events were similar between the two groups. The primary end point of death, myocardial infarction, or target vessel revascularization (TVR) was analyzed as time-to-first event within 9 months of the index PCI. After adjusting for certain baseline characteristics, diabetes was independently associated with death at 9 months ( relative risk [RR], 1.87; 95% CI, 1.31 to 2.68, P < 0.01) and with an increased likelihood of TVR (RR, 1.27; 95% CI, 1.14 to 1.42, P < 0.01), as well as the composite end point of death/myocardial infarction/TVR ( RR, 1.26; 95% CI, 1.13 to 1.40, P < 0.01).Conclusions - Despite advances in interventional techniques, diabetes remains a significant independent predictor of adverse events in the intermediate term after PCI.