支架或药球治疗糖尿病合并支架内再狭窄预后分析

李东东; 朱彬; 杨旺伟; 付国涛; 高超; 陶凌

doi:10.12125/j.chj.202310075

支架或药球治疗糖尿病合并支架内再狭窄预后分析

Long-term performance of drug-coated balloons and drug-eluting stents in diabetic patients with in-stent restenosis

摘要

摘要:
目的研究糖尿病合并支架内再狭窄（in-stent restenosis, ISR）患者单纯使用药物洗脱支架（DES）或药物涂层球囊（DCB）进行经皮冠状动脉介入术（percutaneous coronary intervention，PCI）治疗，探讨两种器械与患者预后关系。
方法前瞻性纳入2015年6月1日～2020年6月1日在空军军医大学第一附属医院行PCI并接受DES或DCB治疗的糖尿病合并支架内再狭窄患者，共700例。其中，DES治疗患者380例，DCB治疗患者320例。主要终点为器械相关复合终点（Device-oriented composite endpoints，DoCE)，包括心源性死亡、靶血管心肌梗死和靶血管血运重建。
结果随访36个月，DoCE发生率支架组8.7%低于药球组18.8%，差异具有统计学意义（P<0.05）。PoCE发生率支架组12.9%低于药球组25.0%，差异具有统计学意义（P<0.05）。
结论糖尿病合并支架内再狭窄患者使用DCB的DoCE和PoCE均高于使用药物洗脱支架患者。

Abstract:
AIM To investigate the relationship between two different treatment approaches, drug-eluting stents (DES) and drug-coated balloons (DCB), and the clinical prognosis of patients with diabetes mellitus (DM) complicated by in-stent restenosis (ISR).
METHODS A total of 700 patients diagnosed with DM and ISR who underwent PCI at Xijing Hospital between June 1, 2015, and June 1, 2020 were enrolled. Among them, 380 patients (54.3%) underwent DES-only treatment, while 320 patients (45.7%) received DCB-only treatment. The primary endpoint was device-oriented composite endpoint (DoCE), defined as a composite endpoint of cardiovascular death, non-fatal target vessel MI (TV-MI), and target lesion revascularization (TLR).
RESULTS At 36 months follow-up,the cumulative incidence of the primary endpoint (DoCE) in the DES group (8.7%) was significantly lower than DCB group (18.8%)(P<0.05). Similarly, the cumulative incidence of the secondary endpoint (PoCE) in the DES group (12.9%) was significantly lower than DCB group (25.0%)(P<0.05).
CONCLUSION The rates of both DoCE and PoCE are higher in patients with DM and ISR who were treated with DCB compared to DES.

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