Clinical outcomes of acute myocardial infarction patients with type 2 diabetes mellitus after primary percutaneous coronary intervention
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摘要:
目的:评价急性心肌梗死(acute myocardial infarction,AMI)合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者直接经皮冠脉介入治疗术后近期与远期主要不良心血管事件(major adverse cardiovascular events,MACE)的发生情况。方法:纳入2011年9月—2015年6月在苏州市立医院北区行直接经皮冠脉介入治疗的AMI患者230例,按照是否合并T2DM分为AMI+T2DM组103例、单纯AMI组127例。比较两组患者的手术成功率、术后30 d和3年的MACE(包括心源性死亡、心力衰竭、靶血管血运重建、支架内血栓)。结果:AMI+T2DM组和单纯AMI组的手术成功率分别为97.6%和99.0%,差异无统计学意义(P > 0.05)。术后30 d,AMI+T2DM组心力衰竭发生率明显高于单纯AMI组(10.67% vs. 3.14%,P=0.03);支架内血栓和靶血管血运重建事件两组间差异均无统计学意义(1.94% vs. 0.79%,4.85% vs. 3.15%,P均> 0.05)。术后3年,AMI+T2DM组的心源性死亡、靶血管血运重建、心力衰竭的发生率明显高于单纯AMI组,差异有统计学意义(8.93% vs. 2.36%,P=0.032;6.79% vs. 0.79%,P=0.024;14.56% vs. 4.72%,P=0.012)。结论:AMI合并T2DM患者,远期靶血管血运重建率明显高于不合并T2DM的患者;心力衰竭的发生率不论近期还是远期均明显高于不合并T2DM的患者。
Abstract:
Objective:To explore the incidence of major adverse cardiovascular events(MACE)in acute myocardial infarction(AMI)patients with type 2 diabetes mellitus(T2DM)after primary percutaneous coronary intervention(PCI). Methods:A total of 230 AMI patients who received primary PCI were included in our hospital from September,2011 to June,2015. The patients were divided into two groups:the AMI+T2DM group(n=103)and the AMI group(n=127). The clinical characteristics,coronary angiographic features,PCI outcomes,and incidence of major adverse cardiovascular events(MACE)including cardiac death,heart failure,target vessel revascularization and thrombosis within the stent at 30 days and 3 years were compared. Results:There was no difference in acute successful rate of intervention between the two groups. At 30 days after PCI,the incidence of heart failure was higher in the AMI+T2DM group than that in the AMI group(10.67% vs. 3.14%,P=0.03). However,no significant differences in rate of thrombosis within stent and target vessel revascularization(TVR)were observed(1.94% vs. 0.79%,4.85% vs. 3.15%,respectively,both P > 0.05). During 3-year follow up period,the incidences of cardiac death,TVR and heart failure were significantly higher in AMI patients with T2DM than without T2DM patients(8.93% vs. 2.36%,P=0.032;6.79% vs. 0.79%,P=0.024;14.56% vs. 4.72%,P=0.012,respectively). Conclusion:Compared to AMI patients without T2DM,the incidence of TVR was significantly higher during long-term follow up and the incidence of heart failure was significantly higher during both short- and long-term follow up in AMI patients with T2DM.