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目的评估药物涂层支架(DES)对防治冠状动脉高危病变和糖尿病患者支架植入术后再狭窄的价值。方法126例接受雷帕霉素或紫杉醇DES植入术的冠心病患者为DES组,至少具备下列情况之一糖尿病或糖耐量异常;前降支病变;小血管病变(直径≤2.5mm);靶病变再狭窄。同期选择年龄、性别和狭窄程度等因素相匹配的146例行普通支架(BMS)术的冠心病患者为BMS组,比较两组住院和随访期间的心绞痛、非致死性心肌梗死、心源性死亡和靶病变血运重建(TLR)等主要心脏事件(MACE)。结果DES组合并糖尿病、左前降支植入支架数均明显高于BMS组(P<0.01);DES平均内径较BMS显著为小(P<0.01)。MACE发生率DES组(6例,4.8%)显著低于BMS组(40例,27.4%)(P<0.01)。结论DES能有效地降低冠状动脉高危病变和合并糖尿病患者冠状动脉支架内再狭窄率,进而减少MACE的发生率。
Objective To evaluate the value of drug-eluting stent (DES) in prevention and treatment of restenosis after high-risk coronary artery disease and stenting in patients with diabetes mellitus. Methods One hundred and sixty-six patients with coronary artery disease treated with rapamycin or paclitaxel DES were at least one of the following: diabetic or impaired glucose tolerance; anterior descending coronary artery disease; small vessel disease (diameter ≤ 2.5 mm); target Restenosis. During the same period, 146 patients with coronary artery disease undergoing BMS were selected as BMS group according to the age, sex and the degree of stenosis. Angina pectoris, non-fatal myocardial infarction and cardiac death were compared between the two groups during hospitalization and follow-up And target lesion revascularization (TLR) and other major cardiac events (MACE). Results Compared with BMS group, the number of stents in DES group and DM group was significantly higher than that in BMS group (P <0.01). The mean diameter of DES was significantly smaller than that in BMS group (P <0.01). The incidence of MACE in DES group (6 cases, 4.8%) was significantly lower than that in BMS group (40 cases, 27.4%) (P <0.01). Conclusions DES can effectively reduce coronary in-stent restenosis rate in high-risk coronary artery disease and diabetes mellitus patients, and then reduce the incidence of MACE.