Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2019; 16 (4): 261-313 ➤ Особенности течения заболевания и отдаленные результаты лечения у больных с острым коронарным синдромом и сахарным диабетом

Peculiarities of the disease discharge and long-term results of treatment in patients with acute coronary syndrome and diabetes mellitus

Authors: M.A. Alekseeva, E.U. Asymbekova, N.K. Akhmedyarova, O.M. Sherstyannikova, E.F. Tugeeva, Yu.I. Buziashvili

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2019-16-4-281-292

UDC: 616.132.2-008.6:616.379-008.64]-089.168

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (4): 281-292

Quote as: Alekseeva M.A., Asymbekova E.U., Akhmedyarova N.K., Sherstyannikova O.M., Tugeeva E.F., Buziashvili Yu.I. Peculiarities of the disease discharge and long-term results of treatment in patients with acute coronary syndrome and diabetes mellitus. Сlinical Physiology of Circulation. 2019; 16 (4): 281–92 (in Russ.). DOI: 10.24022/1814-6910-2019-16-4281-292

Keywords:  acute coronary syndrome diabetes coronary heart disease

Received / Accepted:  18.07.2019/28.08.2019

Full text:  

Abstract

Objective: to study the clinical features of the course of the disease in patients with acute coronary syndrome (ACS) in combination with diabetes and long-term results of treatment.
Material and methods. On a voluntary basis, we examined 278 patients with ACS who were admitted to the clinical diagnostic department of the Bakoulev Center, which were subsequently divided into two groups according to the presence or absence of a comorbid state – diabetes. Group 1 consisted of 62 patients with ACS and diabetes, group 2 included 216 patients with ACS.
Results. Patients with ACS and diabetes are distinguished by a higher median age – 59 (40–84) years (p<0.025). They have high rates of body mass index – 30.6 (18.8–40.7) kg/m2, the proportion of patients with obesity was 72.6% (p=0.002). For patients with ACS and diabetes, a common and severe course of atherosclerosis is characteristic: peripheral artery atherosclerosis was found in diabetes by 14.4% more than in the absence of diabetes (p=0.03), diffuse coronary atherosclerosis was prevalent in them (p=0.006), the multiplicity of lesions of the coronary bed (p=0.003). ACS with and without elevation ST were the same in both groups. In both situations, the primary episode of ACS prevailed over the second. In patients with diabetes mellitus, ACS against the background of a previos myocardial infarction was significantly greater than in patients without diabetes mellitus. Percutaneous coronary intervention (PCI) was performed in the 1st group of patients in 66% of cases, in the 2nd group in 71% of cases. Urgent coronary bypass surgery in 1.6% and 3.7% of cases, respectively, delayed coronary bypass surgery – 11.3% and 11.1%. In the acute period of ACS, patients with diabetes have high rates of hospital mortality (8.1% of cases) (p=0.0003). Diabetes mellitus is a significant predictor of hospital mortality in patients with ACS (χ2=9.8, p=0.02). According to the results of re-coronary angiography, the progression of atherosclerosis occurred in 26% of patients with diabetes and 12% in patients without diabetes (p=0.008). Diabetes mellitus affects the progression of atherosclerosis in patients with ACS and myocardial revascularization (χ2=3.6, p=0.05).
Conclusion. When combined with ACS and diabetes, patients were older, with a predominance of the proportion of obese people, severe and widespread atherosclerosis of the coronary and peripheral arteries, with indications of a history of myocardial infarction. With diabetes, there were more women than those without diabetes. Diabetes mellitus is accompanied by high hospital and non-hospital mortality of patients. In the long term – the prognosis for life in such patients is unfavorable, expressed in refractoriness to treatment with statins, progression of atherosclerosis.

References

  1. Shaw J.E., Sicree R.A., Zimmet P.Z. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res. Clin. Pract. 2010; 87: 4–14. DOI: 10.1016/j.diabres.2009.10.007
  2. Viana M.V., Moraes R.B., Fabbrin A.R., Santos M.F., Torman V.B.L. et al. Contrasting effects of preexisting hyperglycemia and higher body size on hospital mortality in critically ill patients: a prospective cohort study. BMC Endocr. Disorders. 2014; 14: 50. DOI: 10.1186/ 1472-6823-14-50
  3. Бокерия Л.А., Голухова Е.З., Сигаев И.Ю., Керен М.А. Современные подходы к хирургическому лечению ишемической болезни сердца у больных сахарным диабетом. Вестник Российской академии медицинских наук. 2012; 67 (1): 20–6. DOI: 10.15690/ vramn.v67i1.105 [Bockeria L.A., Golukhova E.Z., Sigaev I.Yu., Keren M.A. Modern approaches to the surgical treatment of coronary heart disease in patients with diabetes mellitus. Bulletin of the Russian Academy of Medical Sciences. 2012; 67 (1): 20–6 (in Russ.). DOI: 10.15690/ vramn.v67i1.105]
  4. Cooper-DeHoff R.M., Pacanowski M.A., Pepine C.J. Cardiovascular therapies and associated glucose homeostasis: implications across the dysglycemia continuum. J. Am. Coll. Cardiol. 2009; 53 (5 Suppl.): S28–S34. DOI: 10.1016/j.jacc.2008.10.037
  5. Angeli F., Reboldi G., Poltronieri C., Lazzari L., Sordi M., Garofoli M. et al. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications. Therap. Adv. Cardiovasc. Dis. 2015; 9 (6): 412–24. DOI: 10.1177/1753944715594528
  6. Алексеева М.А., Асымбекова Э.У. Острый коронарный синдром при сахарном диабете. Клиническая физиология кровообращения. 2018; 15 (3): 162–8. DOI: 10.24022/1814-6910-2018-15-3-162-168 [Alekseeva M.A., Asymbekova E.U. Acute coronary syndrome in diabetes mellitus. Clinical Physiology of Circulation. 2018; 15 (3): 162–8 (in Russ.). DOI: 10.24022/1814-6910-2018-15-3-162-168]
  7. Haffner S.M., Lehto S., Ronnemaa T., Pyorala 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; 339: 229–34. DOI: 10.1056/NEJM 199807233390404
  8. Rossini R., Cimino A., De Servi S., Grieco N., Lettieri C., Mafrici A. et al. Multidisciplinary management of patients with acute coronary syndrome and diabetes mellitus: from antithrombotic therapy to treatment of hyperglycemia. (PMID: 25072424). Giorn. Ital. Cardiol. 2014; 15 (6): 378–92. DOI: 10.1714/1582. 17284
  9. Lettino M., Andell P., Zeymer U., Widimsky P., Danchin N., Bardaji A. et al. Diabetic patients with acute coronary syndromes in contemporary European registries: characteristics and outcomes. Eur. Heart J. Cardiovasc. Pharmacother. 2017; 3 (4): 198–213. DOI: 10.1093/ehjcvp/pvw049
  10. Gerbaud E., Darier R., Montaudon M., Beauvieux M.C., Coffin-Boutreux C., Coste P. et al. Glycemic variability is a powerful independent predictive factor of midterm major adverse cardiac events in patients with diabetes with acute coronary syndrome. Diabetes Care. 2019; 42 (4): 674–81. DOI: 10.2337/dc18-2047
  11. Buse J.B., Ginsberg H.N., Bakris G.L., Clark N.G., Costa F., Eckel R. et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2007; 115: 114–26.DOI: 10.1161/CIRCULATIONAHA. 106.179294
  12. Engelgau M.M., Geiss L.S., Saaddine J.B., Boyle J.P., Benjamin S.M., Gregg E.W. et al. The evolving diabetes burden in the United States. Ann. Intern. Med. 2004; 140: 945–50. DOI: 10.7326/0003-4819-140-11200406010-00035
  13. Almdal T., Scharling H., Jensen J.S., Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population based study of 13,000 men and women with 20 years of follow-up. Arch. Intern. Med. 2004; 164: 1422–6. DOI: 10.1001/archinte.164.13.1422
  14. Martín-Timón I., Sevillano-Collantes C., SeguraGalindo A., Del Cañizo-Gómez F.J. Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J. Diabetes. 2014; 5: 444–70. DOI: 10.4239/wjd.v5.i4.444
  15. De Rosa S., Chiefari E., Salerno N., Ventura V., D’Ascoli G.L., Arcidiacono B. et al. HMGA1 is a novel candidate gene for myocardial infarction susceptibility. Int. J. Cardiol.2017; 227: 331–4. DOI: 10.1016/j.ijcard. 2016.11.088
  16. Huxley R., Barzi F., Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ. 2006; 332: 73–8. DOI: 10.1136/bmj. 38678.389583
  17. Barrett-Connor E.L., Cohn B.A., Wingard D.L., Edelstein S.L. Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study. JAMA. 1991; 265: 627–31. DOI: 10.1001/jama.1991.03460050081025
  18. Barrett-Connor E., Bush T.L. Estrogen and coronary heart disease in women. JAMA. 1991; 265: 1861–7. DOI: 10.1001/jama.1991.03460140089033
  19. Manson J.E., Colditz G.A., Stampfer M.J., Willett W.C., Krolewski A.S., Rosner B. et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch. Intern. Med. 1991; 151: 1141–7. DOI: 10.1001/archinte.1991. 00400060077013
  20. Olesen K.K.W., Riis A.H., Nielsen L.H., Steffensen F.H., Nørgaard B.L., Jensen J.M. et al. Risk stratification by assessment of coronary artery disease using coronary computed tomography angiography in diabetes and non-diabetes patients: a study from the Western Denmark Cardiac Computed Tomography Registry. Eur. Heart J. Cardiovasc. Imaging. 2019. DOI: 10.1093/ ehjci/jez010
  21. Ricci B., Manfrini O., Cenko E., Vasiljevic Z., Dorobantu M., Kedev S. et al. Primary percutaneous coronary intervention in octogenarians. Int. J. Cardiol. 2016; 222: 1129–35. DOI: 10.1016/j.ijcard.2016.07.204
  22. Savonitto S., Morici N., Nozza A., Cosentino F., Perrone Filardi P., Murena E. et al. Predictors of mortality in hospital survivors with type 2 diabetes mellitus and acute coronary syndromes. Diab. Vasc. Dis. Res. 2018; 15 (1): 14–23. DOI: 10.1177/1479164117735493
  23. Venuraju S.M., Lahiri A., Jeevarethinam A., Cohen M., Darko D., Nair D. et al. Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study. Cardiovasc. Diabetol. 2019; 18 (1): 51. DOI: 10.1186/ s12933-019-0855-8
  24. Jeevarethinam A., Venuraju S., Dumo A., Ruano S., Mehta V.S., Rosenthal M. et al. Relationship between carotid atherosclerosis and coronary artery calcification in asymptomatic diabetic patients: a prospective multicenter study. Clin. Cardiol. 2017; 40 (9): 752–8. DOI: 10.1002/clc.22727
  25. Natali A., Vichi A., Landi A., Serveri A., L’Abbate L., Ferrannini E. Coronary atherosclerosis in type II diabetes: angiographic findings and clinical outcomes. Diabetologia. 2000; 43: 632–41. DOI: 10.1007/ s001250051352
  26. Farkouh M.E., Domanski M., Sleeper L.A., Siami F.S., Dangas G., Mack M. et al. Strategies for multivessel revascularization in patients with diabetes. N. Engl. J. Med. 2012; 367: 2375–84. DOI: 10.1056/NEJMoa 1211585
  27. Verma S., Farkouh M.E., Yanagawa B., Fitchett D.H., Ahsan M.R., Ruel M. et al. Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2013; 1: 317–28. DOI: 10.1016/S22138587(13)70089-5
  28. Бокерия Л.А., Бузиашвили Ю.И., Алекян Б.Г., Асымбекова Э.У., Мацкеплишвили С.Т., Тугеева Э.Ф. и др. Результаты коронарного стентирования убольных ишемической болезнью сердца исахарным диабетом в отдаленные сроки после операции. Грудная и сердечно-сосудистая хирургия. 2006; 5: 12–6. [Bockeria L.A., Buziashvili Yu.I., Alekyan B.G., Asymbekova E.U., Matskeplishvili S.T., Tugeeva E.F. et al. Results of coronary stenting in patients with coronary heart disease and diabetes mellitus in the longterm after surgery. Russian Journal of Thoracic and Cardiovascular Surgery. 2006; 5: 12–6 (in Russ.).]
  29. Бокерия Л.А., Бузиашвили Ю.И., Алекян Б.Г., Асымбекова Э.У., Мацкеплишвили С.Т., Тугеева Э.Ф., Баркалая Л.Р. Эффективность и ближайшие послеоперационные результаты стентирования коронарных артерий у больных ИБС и сахарным диабетом. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2006; 7 (5): 58–65. [Bockeria L.A., Buziashvili Yu.I., Alekyan B.G., Asymbekova E.U., Matskeplishvili S.T., Tugeeva E.F., Barkalaya L.R. Efficacy and immediate postoperative results of coronary artery stenting in patients with coronary artery disease and diabetes. Bulletin of Bakoulev Center. Cardiovascular Diseases. 2006; 7 (5): 58–65 (in Russ.).]
  30. Windecker S., Stortecky S., Stefanini G.G., da Costa B.R., Rutjes A.W., Di Nisio M. et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ. 2014; 348: 3859. DOI: 10.1136/bmj.g3859
  31. Bangalore S., Toklu B., Feit F. Outcomes with coronary artery bypass graft surgery versus percutaneous coronary intervention for patients with diabetes mellitus: can newer generation drug-eluting stents bridge the gap? Circ. Cardiovasc. Interv. 2014; 7: 518–25. DOI: 10.1161/CIRCINTERVENTIONS.114.001346
  32. Ramanathan K., Abel J.G., Park J.E., Fung A., Mathew V., Taylor C.M. et al. Surgical versus percutaneous coronary revascularization in patients with diabetes and acute coronary syndromes. J. Am. Coll. Cardiol. 2017; 70 (24): 2995–3006. DOI: 10.1016/ j.jacc. 2017.10.029
  33. Karjalainen P.P., Airaksinen J.K., de Belder A., Romppanen H., Kervinen K., Sia J. et al. Long-term outcome of early percutaneous coronary intervention in diabetic patients with acute coronary syndrome: insights from the BASE ACS trial. Ann. Med. 2016; 48 (5): 376–83. DOI: 10.1080/07853890.2016.1186829
  34. Liu Z., Xu Y., Hao H., Yin C., Xu J., Li J. et al. Efficacy of high intensity atorvastatin versus moderate intensity atorvastatin for acute coronary syndrome patients with diabetes mellitus. Int. J. Cardiol. 2016; 222: 22–6. DOI: 10.1016/j.ijcard.2016.07.140

About Authors

  • Mariya A. Alekseeva, Postgraduate; orcid.org/0000-0002-3736-2991
  • El’mira U. Asymbekova, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-5422-2069
  • Nazli K. Akhmedyarova, Cand. Med. Sc., Researcher; orcid.org/0000-0001-7157-6312
  • Ol’ga M. Sherstyannikova, Cand. Med. Sc., Researcher; orcid.org/0000-0002-0340-695Х
  • El’vina F. Tugeeva, Dr. Med. Sc., Senior Researcher Yuriy I. Buziashvili, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Clinical-Diagnostic Department; orcid.org/0000-0001-7016-7541


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