Analysis of long-term outcomes of comprehensive treatment for coronary heart disease in patients with prediabetes and overt diabetes mellitus
Keywords:coronary heart disease, diabetes mellitus, atherosclerosis of coronary arteries, percutaneous coronary intervention, coronary artery bypass grafting
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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