| Diabetes is a chronic metabolic disease that is difficult to cure.The number o f diabetic patients in China is large.In 2019,the prevalence of diabetes among adults in China is 9.2%,the number of patients is 116 million,and it continues to increase.It is estimated that by 2045,the number of Chinese diabetic patients will reach 147 million(IDF diabetes atlas,9th Edition 2019),which will bring a heavy burden to the medical system.Type 2diabetes accounts for more than 90%of adult diabetic patients,and more than 60%of patients with type 2 diabetes have secondary cardiovascular disease(CVD),which is the main cause of their death.Type 2 diabetes impairs vascular endothelial function through a variety of mechanisms,which can not only lead to the occurrence and development of coronary atherosclerotic plaques,but also impair the diastolic balance of coronary arteries,promote thrombosis,induce acute coronary syndromes(ACS);In addition,persistent coronary endothelial dysfunction after coronary intervention(PCI)can induce major adverse cardiovascular events(MACE).Therefore vascular endothelial function plays a vital role in cardiovascular disease.Vascular endothelial function not only has pathophysiological significance in cardiovascular disease,but also can be used to predict the risk of cardiovascular dise ase.Endothelial function is regarded as a barometer of the risk of cardiovascular disease,It may represent the balance index between all atherogenic and atherosclerotic protective factors in the body,and may help to manage cardiovascular risk hierarchically.Endothelial dysfunction is a systemic systemic disease.Bonetti P et al.found that the risk of cardiovascular disease can be assessed by detecting peripheral arterial endothelial function and it provide better clinical decisions for patients.Endo-PAT 2000 can non-invasively detect the peripheral arterial reactive hyperemia index(RHI)and it is an effective method for measuring endothelial function.PurposeThis study will explore the prognostic value of the endothelial function reflected by the reactive hyperemia index for 1-year MACE in patients with ACS complicated with type2 diabetes after PCI.MethodA total of 113 ACS patients with type 2 diabetes who underwent PCI treatment at the Xinqiao Hospital of the Army Military Medical University from December 2015 to December 2016 were enrolled.All patients enrolled underwent RHI measurement according to standard procedures and received a 12-month follow-up.ResultDuring the one year follow-up,the incidence of MACE in the RHI<1.67 group was23.73%,and the incidence of MACE in the RHI>1.67 group was 8.70%(P<0.05).Multivariate Cox risk analysis showed that in addition to GRACE score and SYNTAX score,RHI is also a predictor of 1-year MACE in patients with acute coronary syndrome complicated with type 2 diabetes after PCI.When SYNTAX score and GRACE score combined with RHI are used to predict 1-year MACE,the predictive ability of these classic scores can be improved to a certain extent.The values are SYNTAXsc+RHI(ROC-AUC0.726,95%CI 0.594-0.857,p=0.003),GRACEsc+RHI(ROC-AUC 0.753,95%CI0.639-0.867,p=0.001).ConclusionsReactive hyperemia index may be a predictor of MACE events at 1 year after PCI in patients with acute coronary syndrome and type 2 diabetes,and may help identify patients with increased MACE risk... |
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