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Background. Despite modern methods for the diagnosis and treatment of impaired glucose metabolism, diabetes mellitus remains an independent risk factor and doubles the number of cardiovascular events (coronary heart disease, ischemic stroke, death). The effectiveness of modern methods for myocardial revascularization in patients with diabetes mellitus needs further researches. The purpose of this study is to evaluate risk factors and long-term outcomes of coronary artery revascularization in patients with coronary heart disease and concomitant prediabetes or overt diabetes mellitus. Materials and methods. This retrospective study involved 120 individuals with coronary heart disease who underwent revascularization of coronary arteries. Patients were divided into two groups according to the glycemic status: group I (main group) — prediabetes or diabetes mellitus (n = 58); group II (controls) — individuals without impaired glycemia (n = 62). Stenosis of coronary arteries was determined by coronary angiography. Treatment outcomes in both groups of patients were assessed as a progression of coronary artery atherosclerosis (repeated interventions caused by new atherosclerotic lesions or restenosis of preimplanted stent) and mortality rates. The average follow-up of patients in two groups is 3 years (minimum of 24 months). Results. Patients of group I predominantly had triple vessel disease (43.1 vs 16.1 %, p < 0.05); chronic occlusion of the heart vessels was diagnosed more often than in group II (43.1 vs 25.8 %, p < 0.05), which characterizes more severe course of disease. Compared to the control group, in patients of the main group, the incidence of myocardial infarction (45.9 vs 33.9 %, odds ratio (OR) 6.1 (95% confidence interval (CI) 2.76–13.6), p < 0.05), stroke (13.8 vs 3.2 %, OR 4.8 (95% CI 0.97–23.6), p < 0.05) and chronic renal failure (10.3 vs 1.6 %), OR 7.0 (95% CI 0.82–60.4), p < 0.05) was significantly higher. In contrast to individuals without diabetes mellitus, patients from group I had significantly lower systolic heart function (48.9 ± 11.9 % vs 54.61 ± 7.56 %, p < 0.05). Percutaneous coronary intervention was a method of choice for coronary artery revascularization in patients with coronary heart disease, but coronary artery bypass grafting was more commonly used in the presence of diabetes mellitus (24.1 vs 6.5 %, p < 0.05). The progression of coronary artery atherosclerosis prevailed in patients with impaired glucose metabolism (19.0 vs 6.5 %, OR 3.4 (95% CI 1.01–11.3), p < 0.05). Mortality in people from group I was higher (12.1 vs 1.6 %, OR 8.4 (95% CI 1.00–70.3), p < 0.05). Conclusions. Multivascular lesions of the coronary arteries caused a worse prognosis in patients with diabetes mellitus. The development of recurrent circulatory disorders was more common in patients with impaired glucose metabolism. The presence of this pathology significantly increases the risk of myocardial infarction, stroke and chronic renal failure.
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Benjamin EJ, Muntner P, Alonso A, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019 Mar 5;139(10):e56-e528. doi:10.1161/CIR.0000000000000659.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993 Feb;16(2):434-44. doi:10.2337/diacare.16.2.434.
Shore S, Borgerding JA, Gylys-Colwell I, et al. Association between hyperglycemia at admission during hospitalization for acute myocardial infarction and subsequent diabetes: insights from the veterans administration cardiac care follow-up clinical study. Diabetes Care. 2014 Feb;37(2):409-18. doi:10.2337/dc13-1125.
Pajunen P, Koukkunen H, Ketonen M, et al. Myocardial infarction in diabetic and non-diabetic persons with and without prior myocardial infarction: the FINAMI Study. Diabetologia. 2005 Dec;48(12):2519-24. doi:10.1007/s00125-005-0019-0.
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998 Jul 23;339(4):229-34. doi:10.1056/NEJM199807233390404.
Qin SY, Zhou Y, Jiang HX, Hu BL, Tao L, Xie MZ. The association of diabetes mellitus with clinical outcomes after coronary stenting: a meta-analysis. PLoS One. 2013 Sep 16;8(9):e72710. doi:10.1371/journal.pone.0072710.
International Diabetes Federation. IDF Diabetes Atlas – 8th Edition. 2017. Available from: https://www.diabetesatlas.org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf.
Emerging Risk Factors Collaboration; Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010 Jun 26;375(9733):2215-22. doi:10.1016/S0140-6736(10)60484-9.
Dauriz M, Targher G, Laroche C, et al; ESC-HFA Heart Failure Long-Term Registry. Association Between Diabetes and 1-Year Adverse Clinical Outcomes in a Multinational Cohort of Ambulatory Patients With Chronic Heart Failure: Results From the ESC-HFA Heart Failure Long-Term Registry. Diabetes Care. 2017 May;40(5):671-678. doi:10.2337/dc16-2016.
Xie Y, Bowe B, Mokdad AH, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018 Sep;94(3):567-581. doi:10.1016/j.kint.2018.04.011.
Morgan KP, Kapur A, Beatt KJ. Anatomy of coronary disease in diabetic patients: an explanation for poorer outcomes after percutaneous coronary intervention and potential target for intervention. Heart. 2004 Jul;90(7):732-8. doi:10.1136/hrt.2003.021014.
Barry A, Wilkinson I, Halford V, Springett K, McInnes A. A clinical study and the national service framework for diabetes. J Tissue Viability. 2004 Oct;14(4):124, 126, 128, passim. doi:10.1016/s0965-206x(04)44002-9.
Mankovsky G. Angiographic characteristics of the lesions of coronary arteries in patients with ischemic heart disease and diabetes mellitus. Ukrainian Journal of Cardiovascular Surgery. 2018;2(31):27-30. doi:10.30702/ujcvs/18.31/05(027-030). (in Russian).