Objective: To investigate the clinical features and long-term prognostic factors of diabetic patients with low or intermediate complexity coronary artery disease (CAD) post percutaneous coronary intervention (PCI). Methods: This was a prospective, single-centre observational study. Consecutive diabetic patients with SYNTAX score (SS)≤32 undergoing PCI between January and December 2013 in Fuwai hospital were included in this analysis. The patients were divided into two groups based on SS, namely SS≤22 group and SS 23-32 group. Multivariate Cox regression analysis was performed to identify independent factors related to poor 5-year prognosis. The primary outcomes were cardiac death and recurrent myocardial infarction, the secondary outcomes were all cause death and revascularization. Results: Of the 3 899 patients included in the study, 2 888 were men (74.1%); mean age was 59.4±9.8 years. There were 3 450 patients in the SS≤22 group and 449 patients in the SS 23-32 group. Compared with SS≤22 group, the incidence of revascularization was higher in SS 23-32 group (18.9% (85/449) vs. 15.2% (524/3450), log-rank P=0.019). There was no significant difference in all-cause death, cardiac death and recurrent myocardial infarction between the two groups (log-rank P>0.05). Multivariate Cox regression analysis showed that age (HR=1.05, 95%CI 1.02-1.08, P<0.001), chronic obstructive pulmonary disease (HR=3.12, 95%CI 1.37-7.07, P=0.007) and creatinine clearance rate (CCr)<60 ml/min (HR=3.67, 95%CI 2.05-6.58, P<0.001) were independent risk factors for 5-year cardiac death, while left ventricular ejection fraction (HR=0.94, 95%CI 0.91-0.96, P<0.001) was a protective factor. Previous PCI (HR=2.04, 95%CI 1.38-3.00, P<0.001), blood glucose level≥11.1 mmol/L on admission (HR=2.49, 95%CI 1.32-4.70, P=0.005) and CCr<60 ml/min (HR=1.85, 95%CI 1.14-2.99, P=0.012) were independent risk factors for 5-year recurrent myocardial infarction. The SS of 23-32 was independently associated with risk of revascularization (HR=1.54, 95%CI 1.09-2.16, P=0.014), after adjusting for residual SS. Residual SS was not a risk factor for 5-year prognosis. Conclusions: In diabetic patients with low-or intermediate complexity CAD, SS 23-32 is associated with increased risk of 5-year revascularization; the clinical characteristics of the patients are associated with the long-term mortality and recurrent myocardial infarction, but not related to revascularization.
目的： 探讨合并糖尿病、冠状动脉病变解剖中低危（SYNTAX评分≤32）的冠心病患者，经皮冠状动脉介入治疗（PCI）术后远期预后的影响因素。 方法： 本研究为前瞻性单中心观察性研究。连续纳入2013年1至12月在阜外医院行PCI且SYNTAX评分≤32、合并糖尿病的患者。根据患者SYNTAX评分水平分为SYNTAX评分≤22组和23≤SYNTAX评分≤32组。主要终点是5年心原性死亡、再发心肌梗死，次要终点包括5年全因死亡和重复血运重建。采用Cox比例风险回归模型分析PCI术后远期预后的影响因素。 结果： 共纳入3 899例糖尿病合并冠心病患者，年龄（59.4±9.8）岁，其中男性2 888例（74.1%）。SYNTAX评分≤22组3 450例，23≤SYNTAX评分≤32组449例。术后5年，与SYNTAX评分≤22组相比，23≤SYNTAX评分≤32组患者重复血运重建发生率更高［18.9%（85/449）比15.2%（524/3 450），log-rankP=0.019］，两组全因死亡、心原性死亡和再发心肌梗死发生率差异无统计学意义（log-rank P均>0.05）。多因素Cox回归分析结果显示，年龄（HR=1.05，95%CI 1.02~1.08，P<0.001）、慢性阻塞性肺病（HR=3.12，95%CI 1.37~7.07，P=0.007）和血清肌酐清除率（CCr）<60 ml/min（HR=3.67，95%CI 2.05~6.58，P<0.001）是5年心原性死亡的独立危险因素；左心室射血分数（HR=0.94，95%CI 0.91~0.96，P<0.001）是其保护因素。既往PCI史（HR=2.04，95%CI 1.38~3.00，P<0.001）、入院血糖水平≥11.1 mmol/L（HR=2.49，95%CI 1.32~4.70，P=0.005）和CCr<60 ml/min（HR=1.85，95%CI 1.14~2.99，P=0.012）是5年再发心肌梗死的独立危险因素。23≤SYNTAX评分≤32（HR=1.54，95%CI 1.09~2.16，P=0.014）是PCI术后5年重复血运重建的独立危险因素，与全因死亡、心原性死亡或再发心肌梗死均无独立相关性。残余SYNTAX评分与远期预后无关。 结论： 在合并糖尿病且冠状动脉病变中低危的冠心病患者中，SYNTAX评分23~32增加5年重复血运重建风险；患者临床特征与远期死亡、再发心肌梗死等远期心血管事件相关，而血运重建程度与其无关。.