冠状动脉疾病合并糖尿病患者经StentBoost技术指导的经皮冠状动脉介入治疗后5年的随访分析

doi:10.24920/003496

Abstract

Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention (PCI).

Methods From March 2009 to July 2010, 184 patients undergoing PCI at our hospital were found stent underexpansion or malapposition by StentBoost after stents implantation and were divided into the diabetic (n=73, 39.67%) and the non-diabetic group (n=111, 60.33%). All patients received StentBoost-guided post-dilatation after stent implantation. The instant procedural results were measured and clinical outcome after five-year follow-up was analyzed in each group. Between-group comparisons were performed using Chi-square test or Student’s t test. Multivariate logistic regression analysis was carried out to reveal the independent predictors for long-term clinical outcomes of StentBoost-optimized PCI .

Results After StentBoost-guided post-dilatation, the minimum diameter (MinLD), maximum diameter (MaxLD) and average diameter in both groups increased significantly than before (P<0.001), the (MaxLD-MinLD)/MaxLD ratio and the in-stent residual stenosis decreased accordingly (P<0.001). The five-year follow-up showed similar mortality rate (4.92% vs. 2.86%, P=0.67) and major adverse cardiac event rate (11.48% vs. 11.43%, P = 1.0) between the diabetic and the non-diabetic group, whereas the recurrence of angina pectoris was higher in the diabetic group compared to the non-diabetic group (47.54% vs. 29.52%; P=0.02). A multivariate logistic regression analysis revealed that age and left ventricular ejection fraction rather than diabetes mellitus were independent predictors for long-term clinical outcomes.

Conclusions StentBoost could effectively improve instant PCI results; the long-term clinical outcomes of StentBoost-optimized PCI were similar between diabetic and non-diabetic patients. Age and left ventricular ejection fraction were the independent predictors for long-term clinical outcomes.

Key words: percutaneous coronary intervention, diabetes mellitus, stent, prognosis

Chen Qiang, Zhang Liwei, Huang Dangsheng, Zhang Chunhong, Wang Qiushuang, Shen Dong, Xiong Minjun, Yang Feifei. Five-year Clinical Outcomes of CAD Patients Complicated with Diabetes after StentBoost-optimized Percutaneous Coronary Intervention[J].Chinese Medical Sciences Journal, 2019, 34(3): 177-183.

Figures/Tables 4

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Groups	n	Age^§(yrs)	Gender (% male)	Previous MI (%)	Previous PCI (%)	Hypertension (%)	Hyperlipidemia (%)	Smoking status (%)	LVEF^§
Non-DM	111	65.11±11.24	77.48	18.92	18.02	61.26	56.76	46.85	57.85±8.99
DM	73	63.89±10.48	72.60	17.81	15.07	68.49	50.68	36.99	54.80±11.42
χ²/t value		-0.83	0.566	0	0.273	1.001	0.377	1.748	-1.91
P value		0.462	0.486	1.000	0.689	0.349	0.452	0.224	0.065

Parameters	DM group (n = 73)	Non-DM group (n=111)	χ²/t value	P value
Baseline lesion parameters
Single vessel (%)	54.79	52.25	0.114	0.764
Double vessels (%)	28.77	27.93	0.015	0.902
Triple vessels (%)	12.33	16.22	0.532	0.528
Left main lesion (%)	4.11	3.60	0	1.000
Details of stent implantation
Number of stents^§	1.92±1.07	1.76±0.99	1.013	0.313
Stent diameter^§ (mm)	2.92±0.38	2.95±0.37	-0.490	0.507
Stent length^§ (mm)	26.52±6.62	25.64±6.45	0.799	0.227
Maximal pressure^§ (atm)	15.16±2.82	15.67±3.29	-1.000	0.077
Post-dilatation balloon diameter^§ (mm)	3.06±0.43	3.15±0.36	-0.990	0.068
Post-dilatation balloon maximal pressure^§ (atm)	18.09±3.4	17.89±3.31	-0.230	0.517
Instant PCI results
MinLD^§ (mm)	2.76±0.37	2.70±0.35	1.250	0.270
MaxLD^§ (mm)	3.32±0.40	3.23±0.35	0.909	0.110
Average diameter after SB^§ (mm)	3.04±0.38	2.97±0.34	1.134	0.190
(MaxLD-MinLD)/MaxLD ratio^§	0.17±0.04	0.16±0.04	0.862	0.100
Early gain^§ (mm)	0.28±0.18	0.31±0.19	1.351	0.229
Residual stenosis after SB^§ (%)	16.37±2.88	16.23±3.63	0.173	0.780

Post-dilatation measurements	DM group (n = 73)				Non-DM group (n = 111)
Post-dilatation measurements	Before	After	t value	P value	Before	After	t value	P value
MinLD (mm)	2.48±0.39	2.76±0.37	-3.356	0.001	2.39±0.39	2.70±0.35	-3.723	0.000
MaxLD (mm)	3.16±0.41	3.32±0.40	-2.299	0.025	3.06±0.37	3.23±0.35	-2.419	0.017
Average diameter (mm)	2.80±0.53	3.04±0.38	-2.788	0.008	2.74±0.36	2.97±0.34	-3.720	0.000
(MaxLD-MinLD)/MaxLD ratio	0.22±0.06	0.17±0.04	-2.842	0.002	0.22±0.06	0.16±0.04	-2.621	0.001
Residual stenosis (%)	21.89±5.80	16.37±2.88	4.443	0.000	22.53±6.46	16.23±3.63	4.526	0.000

Groups	n	Death	Cardiac death	Non-cardiac death	Non-fatal AMI	Recurrent angina	Revascularization	MACEs
Groups	n	Death	Cardiac death	Non-cardiac death	Non-fatal AMI	Recurrent angina	Revascularization	TLR	TVR	CABG	Total
DM group	61	4.92	0	4.92	1.64	47.54	9.84	3.28	4.92	1.64	11.48
Non-DM group	105	2.86	1.9	0.95	0.95	29.52	8.57	3.81	4.76	0	11.43
χ² value		0.065	-	1.170	0	5.427	0.075	0	0	-	0
P value		0.799	0.532	0.280	1.000	0.020	0.785	1.000	1.000	0.367	1.000

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