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Akut miyokard enfarktüslü hastalarda prediyabetin kardiyovasküler hastalık riskine etkisi

Yıl 2021, , 83 - 87, 02.08.2021
https://doi.org/10.25000/acem.881170

Öz

Amaç: Prediyabetin artmış kardiyovasküler hastalıklar (KVH) riski ve mortalite ile ilişkili olduğu bilinmektedir. Prediyabetik hastaların %70'inden fazlasında Diabetes Mellitus (DM) geliştiği bildirilmiştir. Akut miyokard enfarktüsü (AME) olan hastalarda diyabet, diyabetik olmayan hastalara kıyasla istenmeyen kardiyovasküler olay riskini 2-4 kat artırır. Bu morbidite-mortalite ilişkisi normal glukoz toleransından diyabete ilerleme aşamasında başlar. Yeni tanı almış AME ile başvuran hastalarda, hemoglobin A1c (HbA1c) değerleri kullanılarak prediyabet varlığı ile KVH riski arasındaki ilişkiyi değerlendirdik.
Yöntemler: Bu çalışma retrospektif, tek merkezli olup, Mart 2019-Eylül 2020 tarihleri arasında ardışık olarak, hastanemizde AME tanısı ile koroner anjiyografi yapılan hastalar incelendi. Toplam 332 AME hastası kaydedildi; hastalar HbA1c düzeylerine göre 2 gruba ayrıldı: diyabetik olmayan grup (HbA1c <%5,7, n = 204) ve prediyabetik grup (%5,7 ≤HbA1c <%6,5, n = 128). Birincil bileşik son noktalar, kardiyovasküler ölüm, miyokardiyal enfarktüs ve inme olarak belirlendi.
Bulgular: 332 hastanın 204'ü (%61) diyabetik olmayan gruba, 128 (%39) hasta prediyabetik grup arasındaydı. Takip süresi boyunca, birincil birleşik sonlanım noktaları diyabet olmayan ve prediyabet grubunda %7,4 ve %15,6 olarak bulundu (p = 0,026). Prediyabetik grupta kardiyovasküler ölüm ve miyokard infarktüsü insidansı, diyabetik olmayan gruba göre anlamlı olarak daha yüksekti (sırasıyla p = 0,021, p = 0,004). Çok değişkenli analizi takiben birincil birleşik sonlanım noktaları için bağımsız öngörücüler arasında SYNTAX skoru (OR: 0,912; %95 GA: 0,832- 0,999, p: 0,047) , sol ventriküler ejeksiyon fraksiyonu (OR: 0,812; %95 GA: 0,753- 0,876, p< 0,001), sistolik kan basıncı (OR: 0,955; %95 GA: 0,927- 0,985, p: 0,003) ve kategorik değerli HbA1c (%5,7 ≤HbA1c<%6,5) (OR: 2,787; %95 GA: 1,091- 7,120, p: 0,032) yer aldı.
Sonuç: Prediyabet grubunun diyabet olmayanlara kıyasla birincil bileşik sonlanım noktalarının daha yüksek insidansına sahip olduğu gösterilmiştir. Bileşik sonlanım noktası için bağımsız öngörücü olarak SYNTAX skoru, sol ventriküler ejeksiyon fraksiyonu, sistolik kan basıncı ve HbA1c (kategorik değişken) bulundu. Prediyabet aşamasında önleyici tedbirler, KVH gelişiminin önlenmesine yardımcı olabilir.

Destekleyen Kurum

Yoktur

Kaynakça

  • 1. Authors/Task Force Members, Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34:3035-87.
  • 2. Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, et al. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Anesthesiology. 2008;109:14-24.
  • 3. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 937-52.
  • 4. Balkau B. The DECODE study. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Diabetes Metab. 2000;26:282-6.
  • 5. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364:829-41.
  • 6. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41:S14-s31.
  • 7. Ceyhan K, Altunkaş F. Prediabetes, becoming the equivalent of coronary artery disease. Turk Kardiyol Dern Ars. 2012;40:458-65.
  • 8. Gillett MJ. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: Diabetes Care 2009;32:1327-13. Clin Biochem Rev. 2009;30:197-200.
  • 9. Lankisch M, Füth R, Gülker H, Lapp H, Bufe A, Haastert B, et al. Screening for undiagnosed diabetes in patients with acute myocardial infarction. Clin Res Cardiol. 2008;97:753-9.
  • 10. Vistisen D, Witte DR, Brunner EJ, Kivimäki M, Tabák A, Jørgensen ME, et al. Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study. Diabetes Care. 2018;41:899-906.
  • 11. Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016;355:i5953.
  • 12. Warren B, Pankow JS, Matsushita K, Punjabi NM, Daya NR, Grams M, et al. Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2017;5:34-42.
  • 13. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72: 2231-64.
  • 14. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:S62-9.
  • 15. American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care. 2013;36:S11-66.
  • 16. Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendíc S, Rydén L, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140-4.
  • 17. Kataoka Y, Yasuda S, Morii I, Otsuka Y, Kawamura A, Miyazaki S. Quantitative coronary angiographic studies of patients with angina pectoris and impaired glucose tolerance. Diabetes Care. 2005;28:2217-22.
  • 18. Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol. 2010;55:1310-7.
  • 19. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25:1551-6.
  • 20. Ning F, Tuomilehto J, Pyörälä K, Onat A, Söderberg S, Qiao Q; DECODE Study Group. Cardiovascular disease mortality in Europeans in relation to fasting and 2-h plasma glucose levels within a normoglycemic range. Diabetes Care. 2010;33:2211-6.
  • 21. Chatterton H, Younger T, Fischer A, hunti K; Programme Development Group. Risk identification and interventions to prevent type 2 diabetes in adults at high risk: summary of NICE guidance. BMJ. 2012;345:e4624.
  • 22. Timmer JR, Van Der Horst IC, Ottervanger JP, Henriques JP, Hoorntje JC, de Boer MJ, et al. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. Am Heart J. 2004;148:399-404.
  • 23. Chowdhury TA, Lasker SS. Elevated glycated haemoglobin in non-diabetic patients is associated with an increased mortality in myocardial infarction. Postgrad Med J. 1998;74:480-1.
  • 24. Tomizawa N, Inoh S, Nojo T, Nakamura S. The association of hemoglobin A1c and high risk plaque and plaque extent assessed by coronary computed tomography angiography. Int J Cardiovasc Imaging. 2016;32:493-500.
  • 25. Anselmino M, Wallander M, Norhammar A, Mellbin L, Rydén L. Implications of abnormal glucose metabolism in patients with coronary artery disease. Diab Vasc Dis Res. 2008;5:285-90.
  • 26. Brownlee M. Advanced protein glycosylation in diabetes and aging. Annu Rev Med. 1995;46:223-34.
  • 27. Oliver MF. Sudden cardiac death: the lost fatty acid hypothesis. QJM. 2006;99:701-9.
  • 28. Lal N, Chiu AP, Wang F, Zhang D, Jia J, Wan A, et al. Loss of VEGFB and its signaling in the diabetic heart is associated with increased cell death signaling. Am J Physiol Heart Circ Physiol. 2017;312:H1163-75.
  • 29. Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2012;59:635-43.
  • 30. Kadi H, Ceyhan K, Karayakali M, Celik A, Ozturk A, Koc F, et al. Effects of prediabetes on coronary collateral circulation in patients with coronary artery disease. Coron Artery Dis. 2011;22:233-7.
  • 31. Goldberg RB, Temprosa M, Haffner S, Orchard TJ, Ratner RE, Fowler SE, et al. Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group. Diabetes Care. 2009;32:726-32.
  • 32. Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation. 2007;116:151-7.
  • 33. Kristensen SL, Preiss D, Jhund PS, Squire I, Cardoso JS, Merkely B, et al. Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial. Circ Heart Fail. 2016; 9:e002560.
  • 34. Scognamiglio R, Negut C, Ramondo A, Tiengo A, Avogaro A. Detection of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus. J Am Coll Cardiol. 2006;47:65-71.
  • 35. Fonville S, Zandbergen AA, Koudstaal PJ, den Hertog HM. Prediabetes in patients with stroke or transient ischemic attack: prevalence, risk and clinical management. Cerebrovasc Dis. 2014;37:393-400.
  • 36. Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6:296-303.
  • 37. Otten R, Kline-Rogers E, Meier DJ, Dumasia R, Fang J, May N, et al. Impact of pre-diabetic state on clinical outcomes in patients with acute coronary syndrome. Heart. 2005;91:1466-8.
  • 38. Naito R, Miyauchi K, Ogita M, Kasai T, Kawaguchi Y, Tsuboi S, et al. Impact of admission glycemia and glycosylated hemoglobin A1c on long-term clinical outcomes of non-diabetic patients with acute coronary syndrome. J Cardiol. 2014;63:106-11.
  • 39. Magro M, Nauta S, Simsek C, Onuma Y, Garg S, van der Heide E, et al. Value of the SYNTAX score in patients treated by primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: The MI SYNTAXscore study. Am Heart J. 2011;161:771-81.

Impact of prediabetes on cardiovascular disease risk in patients with acute myocardial infarctions

Yıl 2021, , 83 - 87, 02.08.2021
https://doi.org/10.25000/acem.881170

Öz

Aim: Prediabetes is known to be associated with increased cardiovascular diseases (CVD) risk and mortality. It has been reported that more than 70% of pre-diabetic patients develop Diabetes Mellitus (DM). In patients with acute myocardial infarction (AMI), diabetes increases a 2 to 4 fold risk of adverse cardiovascular events compared to non-diabetic patients. This morbidity-mortality relationship begins in the progression phase from normal glucose tolerance to diabetes. We evaluated the relationship between the presence of pre-diabetes by using hemoglobin A1c (HbA1c) values and CVD risk in patients presenting with newly diagnosed AMI.
Methods: This study was a retrospective, single-centre and we examined consecutive patients who underwent coronary angiography with a diagnosis of AMI at our hospital between March 2019 and September 2020. A total of 332 patients with AMI were enrolled; patients were divided into two groups according to their HbA1c levels: non-diabetic group (HbA1c <5.7%) and pre-diabetic group (5.7% ≤HbA1c <6.05%). The primary composite endpoints were cardiovascular death, myocardial infarction or stroke.
Results: Of the 332 patients, 204 (61%) patients had non-diabetic groups, and 128 (39%) patients were between the pre-diabetic groups. During the follow-up period, the primary composite endpoints amounted to 7.4% and 15.6% in the non-diabetes and prediabetes group (p=0.026). The incidences of cardiovascular death and myocardial infarction were significantly higher in the prediabetic group than the nondiabetic group (p= 0.021, p=0.004; respectively). Independent predictors for the primary composite endpoints following the multivariate analysis included SYNTAX score (odds ratio [OR]: 0.912; %95 confidence interval [CI]: 0.832- 0.999, p: 0.047), left ventricular ejection fraction (OR: 0.812; %95 CI: 0.753- 0.876, p< 0.001), systolic blood pressure (OR: 0.955; %95 CI: 0.927- 0.985, p: 0.003) and valuable categorical HbA1c (5.7% ≤HbA1c<6. 5%) (OR: 2.787; %95 CI: 1.091- 7.120, p: 0.032).
Conclusion: Prediabetes group has been shown to have a higher incidence of the primary composite endpoints than non-diabetes. SYNTAX score, left ventricular ejection fraction, systolic blood pressure, and HbA1c (categorical variable) were found as independent predictors for the primary composite endpoint. Preventive measures in the stage of pre-diabetes might help the prevention of developing CVD.

Kaynakça

  • 1. Authors/Task Force Members, Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34:3035-87.
  • 2. Deedwania P, Kosiborod M, Barrett E, Ceriello A, Isley W, Mazzone T, et al. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Anesthesiology. 2008;109:14-24.
  • 3. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364: 937-52.
  • 4. Balkau B. The DECODE study. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Diabetes Metab. 2000;26:282-6.
  • 5. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Thompson A, Di Angelantonio E, Gao P, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011;364:829-41.
  • 6. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41:S14-s31.
  • 7. Ceyhan K, Altunkaş F. Prediabetes, becoming the equivalent of coronary artery disease. Turk Kardiyol Dern Ars. 2012;40:458-65.
  • 8. Gillett MJ. International Expert Committee report on the role of the A1c assay in the diagnosis of diabetes: Diabetes Care 2009;32:1327-13. Clin Biochem Rev. 2009;30:197-200.
  • 9. Lankisch M, Füth R, Gülker H, Lapp H, Bufe A, Haastert B, et al. Screening for undiagnosed diabetes in patients with acute myocardial infarction. Clin Res Cardiol. 2008;97:753-9.
  • 10. Vistisen D, Witte DR, Brunner EJ, Kivimäki M, Tabák A, Jørgensen ME, et al. Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study. Diabetes Care. 2018;41:899-906.
  • 11. Huang Y, Cai X, Mai W, Li M, Hu Y. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016;355:i5953.
  • 12. Warren B, Pankow JS, Matsushita K, Punjabi NM, Daya NR, Grams M, et al. Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2017;5:34-42.
  • 13. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018; 72: 2231-64.
  • 14. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33:S62-9.
  • 15. American Diabetes Association. Standards of medical care in diabetes--2013. Diabetes Care. 2013;36:S11-66.
  • 16. Norhammar A, Tenerz A, Nilsson G, Hamsten A, Efendíc S, Rydén L, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet. 2002;359:2140-4.
  • 17. Kataoka Y, Yasuda S, Morii I, Otsuka Y, Kawamura A, Miyazaki S. Quantitative coronary angiographic studies of patients with angina pectoris and impaired glucose tolerance. Diabetes Care. 2005;28:2217-22.
  • 18. Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. J Am Coll Cardiol. 2010;55:1310-7.
  • 19. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25:1551-6.
  • 20. Ning F, Tuomilehto J, Pyörälä K, Onat A, Söderberg S, Qiao Q; DECODE Study Group. Cardiovascular disease mortality in Europeans in relation to fasting and 2-h plasma glucose levels within a normoglycemic range. Diabetes Care. 2010;33:2211-6.
  • 21. Chatterton H, Younger T, Fischer A, hunti K; Programme Development Group. Risk identification and interventions to prevent type 2 diabetes in adults at high risk: summary of NICE guidance. BMJ. 2012;345:e4624.
  • 22. Timmer JR, Van Der Horst IC, Ottervanger JP, Henriques JP, Hoorntje JC, de Boer MJ, et al. Prognostic value of admission glucose in non-diabetic patients with myocardial infarction. Am Heart J. 2004;148:399-404.
  • 23. Chowdhury TA, Lasker SS. Elevated glycated haemoglobin in non-diabetic patients is associated with an increased mortality in myocardial infarction. Postgrad Med J. 1998;74:480-1.
  • 24. Tomizawa N, Inoh S, Nojo T, Nakamura S. The association of hemoglobin A1c and high risk plaque and plaque extent assessed by coronary computed tomography angiography. Int J Cardiovasc Imaging. 2016;32:493-500.
  • 25. Anselmino M, Wallander M, Norhammar A, Mellbin L, Rydén L. Implications of abnormal glucose metabolism in patients with coronary artery disease. Diab Vasc Dis Res. 2008;5:285-90.
  • 26. Brownlee M. Advanced protein glycosylation in diabetes and aging. Annu Rev Med. 1995;46:223-34.
  • 27. Oliver MF. Sudden cardiac death: the lost fatty acid hypothesis. QJM. 2006;99:701-9.
  • 28. Lal N, Chiu AP, Wang F, Zhang D, Jia J, Wan A, et al. Loss of VEGFB and its signaling in the diabetic heart is associated with increased cell death signaling. Am J Physiol Heart Circ Physiol. 2017;312:H1163-75.
  • 29. Grundy SM. Pre-diabetes, metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2012;59:635-43.
  • 30. Kadi H, Ceyhan K, Karayakali M, Celik A, Ozturk A, Koc F, et al. Effects of prediabetes on coronary collateral circulation in patients with coronary artery disease. Coron Artery Dis. 2011;22:233-7.
  • 31. Goldberg RB, Temprosa M, Haffner S, Orchard TJ, Ratner RE, Fowler SE, et al. Effect of progression from impaired glucose tolerance to diabetes on cardiovascular risk factors and its amelioration by lifestyle and metformin intervention: the Diabetes Prevention Program randomized trial by the Diabetes Prevention Program Research Group. Diabetes Care. 2009;32:726-32.
  • 32. Barr EL, Zimmet PZ, Welborn TA, Jolley D, Magliano DJ, Dunstan DW, et al. Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Circulation. 2007;116:151-7.
  • 33. Kristensen SL, Preiss D, Jhund PS, Squire I, Cardoso JS, Merkely B, et al. Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial. Circ Heart Fail. 2016; 9:e002560.
  • 34. Scognamiglio R, Negut C, Ramondo A, Tiengo A, Avogaro A. Detection of coronary artery disease in asymptomatic patients with type 2 diabetes mellitus. J Am Coll Cardiol. 2006;47:65-71.
  • 35. Fonville S, Zandbergen AA, Koudstaal PJ, den Hertog HM. Prediabetes in patients with stroke or transient ischemic attack: prevalence, risk and clinical management. Cerebrovasc Dis. 2014;37:393-400.
  • 36. Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6:296-303.
  • 37. Otten R, Kline-Rogers E, Meier DJ, Dumasia R, Fang J, May N, et al. Impact of pre-diabetic state on clinical outcomes in patients with acute coronary syndrome. Heart. 2005;91:1466-8.
  • 38. Naito R, Miyauchi K, Ogita M, Kasai T, Kawaguchi Y, Tsuboi S, et al. Impact of admission glycemia and glycosylated hemoglobin A1c on long-term clinical outcomes of non-diabetic patients with acute coronary syndrome. J Cardiol. 2014;63:106-11.
  • 39. Magro M, Nauta S, Simsek C, Onuma Y, Garg S, van der Heide E, et al. Value of the SYNTAX score in patients treated by primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: The MI SYNTAXscore study. Am Heart J. 2011;161:771-81.
Toplam 39 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orjinal Makale
Yazarlar

Özge Çakmak Karaaslan 0000-0003-0173-4017

Murat Oğuz Özilhan Bu kişi benim 0000-0003-4801-966X

Cem Çöteli Bu kişi benim 0000-0001-5520-7103

Orhan Maden Bu kişi benim 0000-0003-3170-1179

Yayımlanma Tarihi 2 Ağustos 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

Vancouver Çakmak Karaaslan Ö, Özilhan MO, Çöteli C, Maden O. Impact of prediabetes on cardiovascular disease risk in patients with acute myocardial infarctions. Arch Clin Exp Med. 2021;6(2):83-7.