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目的观察急性心肌梗死合并2型糖尿病(T2DM)患者的冠状动脉(冠脉)病变特点和冠脉内支架置入术后的远期疗效。方法将2002年10月至2007年8月行冠脉内支架置入术的478例急性心肌梗死患者分为T2DM组(213例)和非DM组(265例)。对2组的冠状动脉病变情况及干预后远期疗效情况作对比。结果与非DM组比较,T2DM组冠脉病变数较多(3.11±1.32 vs 2.74±1.18,P<0.05),2支(40.84% vs 33.58%,P<0.05)和3支病变比例高(30.52% vs 21.89%,P<0.05),弥漫病变(35.21% vs 20.75%,P<0.01)和慢性闭塞性病变(16.90% vs 10.94%,P<0.05)多见。随访6～71(38.50±5.70)个月,2组临床随访率均在93%以上;比较2组随访事件的累积发生率,T2DM组较非DM组支架内再狭窄人月发生率明显增高(56.11×10-4 vs 23.17×10-4,P<0.01),再次血运重建人月发生率明显增高(77.14×10-4 vs 50.16×10-4,P<0.01)。结论合并2型T2DM的急性心肌梗死患者冠脉病变重。T2DM是支架内再狭窄、再次血运重建和主要心血管事件的独立预测因子。
Objective To observe the characteristics of coronary artery (coronary artery) in patients with acute myocardial infarction complicated with type 2 diabetes mellitus (T2DM) and the long-term effect after coronary stent implantation. Methods 478 patients with acute myocardial infarction undergoing coronary stenting from October 2002 to August 2007 were divided into T2DM group (213 cases) and non-DM group (265 cases). Coronary artery lesions in two groups and long-term efficacy after the intervention for comparison. Results Compared with non-DM group, the number of coronary lesions was significantly higher in T2DM group (3.11 ± 1.32 vs 2.74 ± 1.18, P <0.05), two (40.84% vs 33.58%, P <0.05) % vs 21.89%, P <0.05), diffuse lesions (35.21% vs 20.75%, P <0.01) and chronic occlusive lesions (16.90% vs 10.94%, P <0.05). The follow-up ranged from 6 to 71 months (38.50 ± 5.70) months. The clinical follow-up rates in both groups were above 93%. Comparing the cumulative incidence of follow-up events in 2 groups, the incidence of restenosis in T2DM group was significantly higher than that in non-DM group 56.11 × 10-4 vs 23.17 × 10-4, P <0.01). The incidence of revascularization was significantly higher in men (77.14 × 10-4 vs 50.16 × 10-4, P <0.01). Conclusions Patients with acute myocardial infarction complicated with type 2 T2DM have severe coronary artery disease. T2DM is an independent predictor of in-stent restenosis, revascularization, and major cardiovascular events.