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首页> 外文期刊>Circulation journal >Impact of diabetes on cardiovascular outcomes in hemodialysis patients undergoing coronary revascularization.
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Impact of diabetes on cardiovascular outcomes in hemodialysis patients undergoing coronary revascularization.

机译：糖尿病对接受冠状动脉血运重建的血液透析患者的心血管结局的影响。

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BACKGROUND: Among hemodialysis (HD) patients, those who have diabetes have poorer cardiovascular outcomes than non-diabetic patients, but the impact of diabetes on cardiovascular outcomes has not been fully elucidated in HD patients undergoing coronary revascularization. METHODS AND RESULTS: We identified 375 HD patients (203 diabetes, 172 non-diabetes) and 9,006 patients without HD (3,455 diabetes, 5,551 non-diabetes) in the database of the CREDO-Kyoto registry of patients undergoing their first coronary revascularization. In non-HD patients, significantly higher risks of death (10.8% vs. 7.7%, P < 0.0001; adjusted hazard ratio (HR) 1.29, P < 0.0001) and major adverse cardiovascular events (MACE), a composite of death, myocardial infarction and stroke (18.8% vs. 13.3%, P < 0.0001; HR 1.36, P < 0.0001) were seen in diabetic patients than in non-diabetic patients through 4-year follow-up. Analysis in HD patients showed that the duration of HD before first coronary revascularization was significantly shorter in diabetic patients than in non-diabetic patients (median interval: 858 vs. 2,216 days, P < 0.0001). In contrast to the results in non-HD patients, the risks of death (41.9% vs. 39.1%, P=0.75; HR 0.98, P=0.93) and MACE (45.6% vs. 45.8%, P=0.83; HR 0.87, P=0.50) after first revascularization were comparable between diabetic and non-diabetic HD patients. There were significant interactions between HD and diabetes for death and for MACE. CONCLUSIONS: HD patients who require coronary revascularization have extremely poor outcomes irrespective of concomitant diabetes.
机译：背景：在血液透析（HD）患者中，患有糖尿病的患者的心血管结局要比非糖尿病患者差，但是在进行冠脉血管重建的HD患者中，糖尿病对心血管结局的影响尚未完全阐明。方法和结果：我们在首次行冠状动脉血运重建术的患者的CREDO-Kyoto注册表数据库中确定了375例HD患者（203例糖尿病，172例非糖尿病）和9,006例无HD病例（3,455例糖尿病，5,551例非糖尿病）。在非HD患者中，死亡风险显着较高（10.8％与7.7％，P <0.0001;调整后的危险比（HR）1.29，P <0.0001）和主要的不良心血管事件（MACE），是死亡，心肌的综合在4年的随访中，与非糖尿病患者相比，糖尿病患者的梗死和中风发生率分别为18.8％和13.3％，P <0.0001; HR 1.36，P <0.0001。对HD患者的分析表明，与非糖尿病患者相比，糖尿病患者首次冠状动脉血运重建之前的HD持续时间明显短（中位间隔：858天与2,216天，P <0.0001）。与非HD患者的结果相反，死亡风险（41.9％vs. 39.1％，P = 0.75; HR 0.98，P = 0.93）和MACE（45.6％vs. 45.8％，P = 0.83; HR 0.87 ，P = 0.50）在第一次血运重建后在糖尿病和非糖尿病高清患者之间是可比的。 HD和糖尿病在死亡和MACE之间存在显着的相互作用。结论：需要合并冠状动脉血运重建的高清患者，无论是否伴有糖尿病，其预后极差。

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