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目的:比较雷帕霉素洗脱支架(DES)置入术与冠状动脉搭桥术(CABG)治疗糖尿病并发冠状动脉多支病变患者的近中期疗效。方法:回顾性分析2003-07-01-2004-06-30入院并接受DES置入或CABG治疗的糖尿病患者490例的基础临床资料、院内及院外随访资料,比较不同冠状动脉血运重建方式对糖尿病多支病变患者临床结果的影响。结果:250例患者接受DES置入(DES组),240例患者选择CABG治疗(CABG组)。与DES组相比,CABG组患者的冠状动脉病变更为复杂,左主干病变以及慢性闭塞病变的比例较高;DES组弥漫长病变以及再狭窄病变的比例较高。CABG组与DES组院内不良心脑血管事件(MACCE)发生率差异无统计学意义(3.3%∶1.2%,P>0.05)。共有440例患者接受了不同形式的随访,随访率为89.7%。2组患者随访病死率、非致死性脑卒中以及非致死性心肌梗死的发生率均差异无统计学意义;但DES组患者需要再次血运重建的比例明显高于CABG组(11.3%∶1.9%,P<0.01);DES组患者随访MACCE发生率高于CABG组(17.4%∶8.6%,P<0.01)。再次血运重建比例较高是导致DES组随访不良事件增加的主要原因。结论:糖尿病多支病变患者CABG后近中期MACCE发生率低于DES置入术。
Objective: To compare the short-term and long-term effects of rapamycin-eluting stent (DES) implantation and coronary artery bypass grafting (CABG) in the treatment of diabetic patients with coronary artery disease. Methods: The clinical data of 490 patients admitted to hospital from 2003-07-01-2004-06-30 with DES or CABG were retrospectively analyzed. The follow-up data of hospital and hospital were compared, and the coronary revascularization Effect of multidimension diabetic patients on clinical outcome. Results: 250 patients underwent DES placement (DES group) and 240 patients underwent CABG treatment (CABG group). In the CABG group, coronary lesions were more complicated than those in the DES group, with a higher proportion of left main and chronic occlusive lesions, and a higher proportion of diffuse and restenotic lesions in the DES group. There was no significant difference in the incidence of MACCE between CABG group and DES group (3.3%: 1.2%, P> 0.05). A total of 440 patients underwent different forms of follow-up, with a follow-up rate of 89.7%. The follow-up mortality, non-fatal stroke and the incidence of non-fatal myocardial infarction in the two groups were not significantly different. However, the proportion of re-revascularization in DES group was significantly higher than that in CABG group (11.3% vs 1.9% , P <0.01). The incidence of MACCE followed up in DES group was higher than that in CABG group (17.4% vs 8.6%, P <0.01). The higher proportion of revascularization again was the main reason for the increase of follow-up adverse events in DES group. CONCLUSION: The incidence of MACCE in patients with multi-vessel disease is lower than that of DES after CABG.