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目的:评价对糖尿病多支冠状动脉病变患者的裸支架(BMS)置入、药物洗脱支架(DES)置入和冠状动脉搭桥手术(CABG)3种不同血管重建的疗效。方法:选择接受血管重建治疗的糖尿病伴多支冠状动脉病变患者427例,比较其BMS、DES和CABG不同治疗方法的疗效和随访2年的临床结果。结果:BMS、DES和CABG3组间住院时期的不良心脑血管事件(MACCE)发生率比较,差异均无统计学意义。2年随访结果中,BMS组、DES组再次血管重建率分别为17.6%、10.4%,均显著高于CABG组的1.9%(P<0.01);BMS组的总MACCE发生率为23.1%,显著高于CABG组的10.7%(P<0.01),而DES的总MACCE发生率与CABG组相比差异无统计学意义。结论:糖尿病多支血管病变患者置入BMS后再次血管重建率和总MACCE发生率显著高于CABG,而DES的中期临床疗效并不逊于CABG。
OBJECTIVE: To evaluate the efficacy of three different vascular reconstructions of BMS, DES, and CABG in patients with diabetic multiple coronary lesions. Methods: Forty-two patients with diabetes mellitus and multiple coronary lesions undergoing revascularization were enrolled in this study. The curative effect of different treatments of BMS, DES and CABG and the follow-up of 2 years of clinical results were compared. Results: There was no significant difference in incidence of adverse cardiac and cardiovascular event (MACCE) during hospitalization between BMS, DES and CABG3 groups. At 2-year follow-up, the rates of revascularization in BMS group and DES group were 17.6% and 10.4%, respectively, which were significantly higher than those in CABG group (1.9%, P <0.01). The incidence of MACCE in BMS group was 23.1% Which was 10.7% (P <0.01) in CABG group, while there was no significant difference in the total MACCE incidence between DES and CABG group. CONCLUSIONS: The rates of revascularization and total MACCE in patients with diabetic multivessel disease after BMS implantation are significantly higher than those of CABG, while the mid-term clinical efficacy of DES is no worse than that of CABG.