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目的比较经皮冠状动脉介入治疗(PCI)支架术与冠状动脉旁路移植术(CABG)治疗冠心病合并糖尿病患者住院与临床随访结果。方法入选2001年7月至2004年6月在DESIRE注册的1040例冠心病合并糖尿病的患者,分别接受PCI治疗和CABG治疗,对所有患者的临床情况与冠状动脉造影特征、血运重建情况、住院临床结果以及临床随访结果进行回顾性分析。结果与CABG组相比,PCI组的院内主要不良心脑血管事件(MACCE)发生率较低(P<0.01);院内病死率较低(P<0.01);多因素Logistic回归分析显示,CABG组院内MACCE发生的风险显著高于PCI组(P=0.002)。平均随访22个月,两组随访MACCE发生率差异无统计学意义(P>0.05);PCI组再次血运重建率高于CABG组(P<0.01)。多因素Cox回归分析表明,两组随访MACCE风险差异无统计学意义(P>0.05)。结论冠心病合并糖尿病患者PCI术后院内MACCE发生率较低,但PCI后随访再次血运重建率高于CABG。广泛应用药物洗脱支架有望改善PCI的长期结果。
Objective To compare the hospitalization and clinical follow-up of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with coronary heart disease complicated with diabetes mellitus. Methods A total of 1040 coronary heart disease patients with diabetes mellitus who were enrolled in the DESIRE from July 2001 to June 2004 were enrolled in the PCI and CABG respectively. The clinical data, coronary angiography, revascularization, Clinical results and clinical follow-up results were retrospectively analyzed. Results Compared with CABG group, the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) was lower in PCI group than in CABG group (P <0.01), and the mortality in hospital was lower (P <0.01). In multivariate Logistic regression analysis, Hospital MACCE risk was significantly higher than the PCI group (P = 0.002). The mean follow-up was 22 months. There was no significant difference in the incidence of MACCE between two groups (P> 0.05). The rate of revascularization in PCI group was higher than that in CABG group (P <0.01). Multivariate Cox regression analysis showed that there was no significant difference in MACCE risk between the two groups (P> 0.05). Conclusion The incidence of MACCE in patients with coronary heart disease complicated with diabetes is lower after PCI, but the rate of follow-up revascularization after PCI is higher than that of CABG. The widespread use of drug-eluting stents is expected to improve the long-term outcome of PCI.