Prevalence and Procedural Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Patients with Diabetes and Multivessel Coronary Artery Disease
Prevalence and Procedural Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in Patients with Diabetes and Multivessel Coronary Artery Disease
复制标题
DOI：
10.1111/j.1540-8191.2010.01072.x
复制
发表时间：
2011-01-01
影响因子：
1.6
通讯作者：
Aldea, Gabriel S.
中科院分区：
文献类型：
--
作者：
Mokadam, Nahush A.;Melford, Ryland E., Jr.;Aldea, Gabriel S.
背景：经皮冠状动脉介入治疗（PCI）在糖尿病和多支血管病变患者中的应用频率越来越高.本研究调查了华盛顿州不断发展的血运重建策略。研究方法：临床结局评估项目涵盖了华盛顿州的所有血运重建，并用于比较1999年至2007年接受首次血运重建的多支血管疾病糖尿病患者。分类变量采用卡方检验进行比较，连续变量采用学生t检验进行比较。使用logistic回归对结果进行风险调整。结果如下：从1999年到2007年，共有11，602例糖尿病和多支血管疾病患者接受了血运重建，其中冠状动脉旁路移植术（CABG）（51%）和PCI（49%）几乎各占一半。接受CABG的患者充血性心力衰竭、脑血管疾病、外周血管疾病、三支冠状动脉疾病（CAD）和主动脉内球囊反搏植入的患病率较高（p < 0.0001），但女性、心源性休克和急诊操作的患病率较低。接受CABG的患者有更多（p < 0.0001）的三支血管CAD和更多的完全血运重建（3.7 vs. 1.5处病变治疗）。短期风险调整死亡率相当。PCI的患病率从1999年的34.1%上升到2007年的59.4%。结论：PCI在糖尿病合并多支血管病变患者中的应用日益增多。PCI最常用于双血管CAD或急性冠状动脉综合征，具有更有限和更有针对性的血运重建。冠状动脉旁路移植术更常用于广泛的疾病，血运重建更完全。接受PCI作为糖尿病多支血管疾病主要治疗的患者的患病率和百分比都在增加。可能需要采取多学科方法，以确保最佳结果。（J Card Surg 2011;26：1-8）。
P>Background: Percutaneous coronary intervention (PCI) is used with increasing frequency in patients with diabetes and multivessel disease. This study investigated evolving revascularization strategies in the State of Washington. Methods: The Clinical Outcomes Assessment Program captures all revascularization in the State of Washington and was used to compare diabetic patients with multivessel disease undergoing first-time revascularization from 1999 to 2007. Categorical variables were compared with the chi-squared test and continuous variables were compared with the student's t-test. Results were risk-adjusted using a logistic regression. Results: A total of 11,602 patients with diabetes and multivessel disease underwent revascularization from 1999 to 2007 and were nearly equally divided between coronary artery bypass grafting (CABG) (51%) and PCI (49%). Patients undergoing CABG had a higher (p < 0.0001) prevalence of congestive heart failure, cerebrovascular disease, peripheral vascular disease, three-vessel coronary artery disease (CAD), and intraaortic balloon pump insertion, but a lower prevalence of female gender, cardiogenic shock, and emergency procedures. Patients undergoing CABG had more (p < 0.0001) three-vessel CAD and more complete revascularization (3.7 vs. 1.5 lesions treated). Short-term risk-adjusted mortality was equivalent. The prevalence of PCI increased from 34.1% in 1999 to 59.4% in 2007. Conclusions: PCI is applied with increasing frequency to patients with diabetes mellitus (DM) and multivessel disease. PCI is used most commonly in two-vessel CAD or with acute coronary syndromes with more limited and targeted revascularization. CABG is more commonly applied to extensive disease with more complete revascularization. Both the prevalence and percentage of patients undergoing PCI as primary therapy for multivessel disease with DM is increasing. A multidisciplinary approach may be warranted to ensure optimal outcomes. (J Card Surg 2011;26:1-8).