Objective: To investigate the impact of type 2 diabetes mellitus on progression and revascularization of coronary non-target lesions in patients with coronary heart disease. Methods: From January 2010 to September 2014, we retrospectively analyzed the clinical data of patients with coronary heart disease who underwent two consecutive coronary angiographies at Fuwai Hospital. At least one coronary non-target lesion was recorded at the first procedure in these patients. Patients were grouped according to the diagnose of type 2 diabetes mellitus. Demographic features, risk factors of coronary heart disease, laboratory results as well as characteristics of coronary non-target lesions were collected at baseline (first coronary angiography) and follow-up (second coronary angiography). Lesion progression was defined by quantitative coronary angiography analysis. Lesions revascularization was recorded. Multivariable Cox regression analysis was used to define the impacts of diabetes mellitus on progression and revascularization of non-target lesions. Subgroup analysis in diabetic and non-diabetic groups were further performed. Receiver operating characteristics curve was used to identify the predictive value of HbA1c. Results: A total of 1 255 patients were included, and 1 003(79.9%) were male, age was(58.0±9.7) years old. And 486 patients were diagnosed with type 2 diabetes mellitus. Follow-up time was (14.8±4.5) months. Compared with non-diabetic group, diabetic group were older with less male and had higher BMI index as well as higher prevalence of hypertension, dyslipidemia, prior myocardial infarction and prior percutaneous coronary intervention(all P<0.05). Diabetic patients also had higher level of white blood cells, erythrocyte sedimentation rate, C-reactive protein, endothelin and HbA1c at both baseline and follow-up compared with non-diabetic patients (all P<0.01). There was no significant difference on progression of non-target lesions (20.0%(97/486) vs. 18.5%(142/769), P=0.512), revascularization of non-target lesions (13.2%(64/486) vs. 15.9%(122/769), P=0.190) and non-target lesion related myocardial infarction(1.9%(9/486) vs. 1.3%(10/769), P=0.436) between diabetic and non-diabetic patients. Multivariable Cox regression analysis revealed that diabetes mellitus was not an independent predictor for progression and revascularization of non-target lesions (Both P>0.05). Subgroup analysis in diabetic patients showed that baseline HbA1c level(HR=1.160, 95%CI 1.009-1.333, P=0.037) was an independent predictor for non-target lesion progression. Cut-off value of HbA1c was 6.5% (Area Under Curve(AUC) 0.57, specificity 88.7%; sensitivity 24.2%, P=0.046) by receiver operating characteristics curve. Patients with HbA1c level above 6.5% had 2.8 times higher risk of lesion progression compared with patients with HbA1c level below 6.5% (HR=2.838, 95%CI 1.505-5.349, P=0.001). Compared with non-diabetic patients, diabetic patients with HbA1c below 6.5% also had lower risk of lesion progression (HR=0.469, 95%CI 0.252-0.872, P=0.012). ST-segment elevated myocardial infarction was an independent predictor for revascularization of non-target lesions in diabetic patients. Conclusion: Type 2 diabetes mellitus is not an independent predictor for progression and revascularization of coronary non-target lesions in patients with coronary heart disease. However, elevated HbA1c level is a risk factor for progression of non-target lesion in patients with type 2 diabetes mellitus.
目的： 探讨合并2型糖尿病对冠心病患者冠状动脉非靶病变进展和血运重建的影响。 方法： 回顾性分析阜外医院2010年1月至2014年9月期间连续2次接受冠状动脉造影的冠心病患者的临床资料。患者均在第1次冠状动脉造影时记录到了至少1处冠状动脉非靶病变，依据其是否合并2型糖尿病分为糖尿病组和非糖尿病组。收集纳入患者基线（第1次冠状动脉造影时）及随访时（第2次冠状动脉造影时）的人口学特征、冠心病危险因素以及2次冠状动脉造影时的非靶病变特征和实验室检验结果。通过对比2次冠状动脉造影定量分析结果判断冠状动脉非靶病变是否进展，记录纳入患者的血运重建情况。采用多因素Cox回归分析探讨2型糖尿病是否影响冠状动脉非靶病变进展和血运重建的发生，并在糖尿病和非糖尿病亚组中进一步分析冠状动脉非靶病变进展和血运重建的影响因素。使用受试者工作特征（ROC）曲线评价HbA1c的界值。 结果： 共纳入1 255例患者，男性1 003例（79.9%），年龄（58.0±9.7）岁。其中糖尿病组486例，非糖尿病组769例。随访（14.8±4.5）个月。与非糖尿病组比较，糖尿病组患者年龄较大，男性患者比例较低，体重指数较高，合并高血压、高脂血症、心肌梗死病史和既往经皮冠状动脉介入治疗（PCI）的比例均较高（P均<0.05）。糖尿病组患者基线和随访的白细胞、血沉、C反应蛋白、内皮素和糖化血红蛋白（HbA1c）水平都高于非糖尿病组（P均<0.01）。糖尿病组患者与非糖尿病组患者在病变进展[20.0%（97/486）比18.5%（142/769），P=0.512]、病变血运重建[13.2%（64/486）比15.9%（122/769），P=0.190]、非靶病变相关心肌梗死[1.9%（9/486）比1.3%（10/769），P=0.436]方面差异无统计学意义。多因素Cox回归分析结果显示，糖尿病不是病变进展和血运重建的独立影响因素（P均>0.05）。在糖尿病组患者中，基线HbA1c水平是非靶病变进展的独立危险因素（HR=1.160，95%CI 1.009~1.333，P=0.037）；ROC曲线显示，HbA1c的临界值为6.5%（曲线下面积0.57，敏感度为88.7%，特异度为24.2%，P=0.046）；HbA1c≥6.5%的患者出现病变进展的概率约为HbA1c<6.5%患者的2.8倍（HR=2.838，95%CI 1.505~5.349，P=0.001）。与非糖尿病患者相比，HbA1c<6.5%的糖尿病患者病变进展风险更低（HR=0.469，95%CI 0.252~0.872，P=0.012）。另外，诊断为ST段抬高型心肌梗死是合并糖尿病患者发生非靶病变血运重建的独立危险因素（HR=1.962，95%CI 1.012~3.803，P=0.046）。 结论： 合并糖尿病不影响冠心病患者冠状动脉非靶病变的进展和血运重建，但HbA1c升高是合并糖尿病的冠心病患者非靶病变进展的独立危险因素。.
Keywords: Coronary artery disease; Coronary non-target lesion; Revascularization; Type 2 diabetes mellitus.