Prognoza bolesnika sa dijabetes melitusom i višesudovnom koronarnom arterijskom bolešću lečenih perkutanim koronarnim intervencijama

Abstract

Pacijenti sa akutnim koronarnim sindromom (AKS) i dijabetes melitusom (DM) imaju povećan rizik za pojavu velikih neželjenih kardiovaskularnih događaja (VNKD) nakon perkutane koronarne intervencije (PKI), a koji je nedovoljno višedimenzionalno procenjen u odnosu na vrstu i težinu AKS i/ili DM i angiografske nalaze. Cilj: Studija je imala za cilj da proceni i uporedi prediktivnu kliničku vrednost modifikovanog SYNTAX skora u odnosu na prediktivnu kliničku vrednost SYNTAX skora na jednogodišnju pojavu VNKD kod bolesnika sa DM (sa dijagnozom dužom od jedne godine i višesudovnom bolešću) i akutnim koronarnim sindromom (AKS), lečenih metodom PKI. Materijal i metode: Sprovedena je prospektivna studija preseka kod pacijenata sa DM i AKS, kojima su u periodu PKI evidentirani sledeći faktori rizika: 1) metaboličke varijable – glikozilirani hemoglobin (HbA1c), ukupni holesterol, trigliceridemija; 2) endokrinološke varijable – terapija DM, tip DM; 3) modaliteti AKS 4) radiološke / anatomske varijable – SYNTAX skor i 5) kliničke varijable u modifikovanom ACEF skoru i klinički SYNTAX skor. VNKD evidentirani su do godinu dana posle PKI. Rezultati: Nakon PKI, od konsekutivno uključenih 136 pacijenata, njih 55 razvilo je bar jedan VNKD u periodu praćenja od jedne godine. Konstruisana su dva visoko prediktivna indeksa rizika za VNKD (IRVNKD). Prvi indeks rizika – IRNVKD (c statistic = 0.879) definisan je SYNTAX skorom > 21, modifikovanim ACEF skom > 1.38, HbA1c ≥ 8 (%), trigliceridemijom ≥ 2.3 (mmol/L) kod pacijenata na insulinsulinskoj terapiji, kao i modalitetom ACS – nestabilna angina pektoris. IRVNKD ima bolje prediktivne karakteristike u odnosu na SYNTAX skor (c statistic = 0.798), kao i ACF skor, ali ne i u odnosu na klinički SYNTAX skor (c statistic = 0.820). Drugi indeks rizika – IRNVKD II (c statistic = 0.923) definisan je istim faktorima rizika kao i IRNVKD, izuzev HbA1c ≥ 8 (%), a koji dodatno kao faktor rizika sadrži i prisustvo trosudovne bolesti. IRNVKD II imao je značajno bolje prediktivne karakteristike u odnosu na sve pomenute skorove, ali i u odnosu na IRNVKD...

Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) have an increased risk of major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI), which is not estimated sufficiently-multidimensionally in terms of type and severity of the ACS and/or DM and angiographic findings. The Aim: The study was intended to estimate and compare the predictive clinical value of the modified SYNTAX score versus the predictive clinical value of the SYNTAX score to the one-year appearance of MACE after conducted PCI in patients with DM (with diagnosis longer than one year and multivessel disease) and acute coronary syndrome (ACS). Material and methods: A prospective cross-section study was performed in patients with DM and ACS. In the PCI period the following risk factors where were recorded: 1) age and metabolic variables – glycosylated hemoglobin (HbA1c), total cholesterol, triglyceridemia; 2) endocrinological variables – DM therapy, tip of DM; 3) ACS modality; 4) radiological / anatomical variable – SYNTAX score and 5) clinical variables in modified ACEF score and clinical SYNTAX score. One-year MACE were recorded. Results: From a total of 136 consecutive patients, 55 of them developed at least one MACE in one-year follow-up. Two highly predictable MACE risk indexes (MACERI) were constructed. The first risk index – MACERI (c statistic = 0.879) was defined by: SYNTAX score > 21, modified ACEF > 1.38, HbA1c ≥ 8 (%), triglyceridemia ≥ 2.3 (mmol / L) in patients on insulin therapy and ACS modality – unstable angina pectoris. MACERI has better predictive characteristics than SYNTAX score (c statistic = 0.798) as well as ACF score, but not in relation to clinical SYNTAX score (c statistic = 0.820)...