İlk tanı akut koroner sendrom ile başvuran hastalarda koroner arter çaplarının prediyabet ve diyabet ile ilişkisinin incelenmesi

Yıl 2022, Cilt: 13 Sayı: 2, 242 - 252, 30.06.2022

Yasin Özen , Özcan Özeke , Mustafa Bilal Özbay , Burak Açar , Mustafa Karakurt , Mevlüt Serdar Kuyumcu , Kadriye Gayretli Yayla , Çağrı Yayla , Ahmet Ertem , Dursun Aras

https://doi.org/10.18663/tjcl.1113964

Öz

Amaç: Diyabetik hastalarda daha yaygın ve şiddetli koroner ateroskleroz vardır ve koroner arter çapları (KAÇ) yaygın
olarak etkilenir, ancak bu durum prediyabetiklerde değerlendirilmemiştir. Bu çalışma, akut koroner sendromlu hastalarda
prediyabetin KAÇ' ları üzerindeki etkilerini araştırdı.
Gereç ve Yöntemler: Bu çalışmaya dahil edilen 266 hasta "normal", "prediyabetik" ve "diyabetik" olmak üzere üç gruba ayrıldı.
Hastaların KAÇ' ları kantitatif koroner anjiyografi tekniği ile hesaplandı. Koroner segmentler belirlenen bölgelerden ölçüldü.
Bulgular: Normal gruptan farklı olarak hem prediyabetin hem de diyabetin proksimal RCA dışında damarlar üzerinde
benzer etkileri olduğunu bulduk. Ayrıca LMCA çapının en çok etkilenen koroner segment olduğunu ve proksimal LAD
çapının en çok etkilenen ikinci segment olduğunu bulduk (her ikisi için p<0,001). Total KAÇ' ları incelendiğinde distal
koroner arter segmentlerinin proximal koronerlere göre daha fazla etkilendiği görüldü (p<0,001).
Sonuç: Bu çalışma, prediyabetik hastaların koroner arter çaplarının diyabet hastalarına benzer şekilde etkilendiğini ve distal
koroner arterlerdeki daralmanın proksimal damarlara göre daha fazla etkilendiğini göstermiştir. Prediyabetin erken tanı ve
tedavisinin, perkütan veya cerrahi revaskülarizasyon için daha uygun bir koroner lezyon sağlamak açısından önemlidir.

Anahtar Kelimeler

koroner arter çapları, HbA1c, prediyabet, akut koroner sendrom

Investigation of the relationship of coronary artery diameters with prediabetes and diabetes in patients with first diagnosis acute coronary syndrome

Öz

Aim: Diabetic patients have a more severe and widespread coronary atherosclerosis, and their coronary artery diameters
(CADs) are widely affected, but this has not been evaluated in prediabetics. This study investigated the effects of
prediabetes on CADs in patients with acute coronary syndrome.
Material and Methods: Two hundred and sixty-six patients included in this study were divided into three groups as
"normal", "prediabetic" and "diabetic". Patients' CADs were calculated via the quantitative coronary angiography technique.
Coronary segments were measured from the designated regions.
Results: We found that both prediabetes and diabetes had similar adverse effects on vessels except the proximal RCA,
unlike the normal group. We also found that the diameter of the LMCA was the most affected coronary segment, and the
diameter of proximal LAD was second segment as affected mostly (p <0.001 for both). When total CADs were analyzed, it
was seen that distal coronary artery segments were more affected than proximal (p <0.001).
Conclusion: This study showed that coronary artery diameters of prediabetic patients were affected similarly to patients
with diabetes, and the narrowing of the distal coronary arteries was more affected than the proximal vessels. Early
diagnosis and treatment of prediabetes is important to provide a more suitable coronary lesion for percutaneous or
surgical revascularization

Anahtar Kelimeler

Coronary Artery Diameter, Prediabetes, Acute Coronary Syndrome, HbA1c

Kaynakça

• 1. 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 (London, England) 2004; 364 (9438):937-952.
• 2. 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). European heart journal 2013; 34 (39):3035-3087.
• 3. Rydén L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). European heart journal 2007; 28 (1):88-136.
• 4. Petursson P, Herlitz J, Lindqvist J, Sjöland H, Gudbjörnsdottir S. Prevalence and severity of abnormal glucose regulation and its relation to long-term prognosis after coronary artery bypass grafting. 2013; 24 (7):577-582.
• 5. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. The New England journal of medicine 2011; 364 (9):829-841.
• 6. Standards of medical care in diabetes. Diabetes care 2005; 28 Suppl 1:S4-s36.
• 7. Gerstein HC, Santaguida P, Raina P, Morrison KM, Balion C, Hunt D, et al. Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: a systematic overview and meta-analysis of prospective studies. Diabetes research and clinical practice 2007; 78 (3):305-312. 8. Kip KE, Faxon DP, Detre KM, Yeh W, Kelsey SF, Currier JW. Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation 1996; 94 (8):1818-1825.
• 9. Pajunen P, Taskinen MR, Nieminen MS, Syvänne M. Angiographic severity and extent of coronary artery disease in patients with type 1 diabetes mellitus. The American journal of cardiology 2000; 86 (10):1080-1085.
• 10. Aronson D, Edelman ER. Revascularization for coronary artery disease in diabetes mellitus: angioplasty, stents and coronary artery bypass grafting. Reviews in endocrine & metabolic disorders 2010; 11 (1):75-86.
• 11. Sugihara M, Miura S, Nishikawa H, Ike A, Mori K, Iwata A, et al. Characteristics of patients and types of lesions in patients with drug-eluting or bare-metal stent implantation in small coronary arteries: from the FU-Registry. Journal of cardiology 2013; 61 (2):117-121.
• 12. Aboyans V, Lacroix P, Criqui MH. Large and small vessels atherosclerosis: similarities and differences. Progress in cardiovascular diseases 2007; 50 (2):112-125. 13. De Luca G, Suryapranata H, de Boer MJ, Ottervanger JP, Hoorntje JC, Gosselink AT, et al. Impact of vessel size on distal embolization, myocardial perfusion and clinical outcome in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Journal of thrombosis and thrombolysis 2009; 27 (2):198-203.
• 14. Kim JB, Kang JW, Song H, Jung SH, Choo SJ, Chung CH, et al. Late improvement in graft patency after coronary artery bypass grafting: Serial assessment with multidetector computed tomography in the early and late postoperative settings. The Journal of thoracic and cardiovascular surgery 2011; 142 (4):793-799.
• 15. McLean RC, Nazarian SM, Gluckman TJ, Schulman SP, Thiemann DR, Shapiro EP, et al. Relative importance of patient, procedural and anatomic risk factors for early vein graft thrombosis after coronary artery bypass graft surgery. The Journal of cardiovascular surgery 2011; 52 (6):877-885.
• 16. Zindrou D, Taylor KM, Bagger JP. Coronary artery size and disease in UK South Asian and Caucasian men. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2006; 29 (4):492-495.
• 17. Biondi-Zoccai GG, Sangiorgi GM, Antoniucci D, Grube E, Di Mario C, Reimers B, et al. Testing prospectively the effectiveness and safety of paclitaxel-eluting stents in over 1000 very high-risk patients: design, baseline characteristics, procedural data and in-hospital outcomes of the multicenter Taxus in Real-life Usage Evaluation (TRUE) Study. International journal of cardiology 2007; 117 (3):349-354.
• 18. O'Connor GT, Morton JR, Diehl MJ, Olmstead EM, Coffin LH, Levy DG, et al. Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. Circulation 1993; 88 (5 Pt 1):2104-2110. 19. Peterson ED, Lansky AJ, Kramer J, Anstrom K, Lanzilotta MJ. Effect of gender on the outcomes of contemporary percutaneous coronary intervention. The American journal of cardiology 2001; 88 (4):359-364.
• 20. Yang F, Minutello RM, Bhagan S, Sharma A, Wong SC. The impact of gender on vessel size in patients with angiographically normal coronary arteries. Journal of interventional cardiology 2006; 19 (4):340-344.
• 21. Fisher LD, Kennedy JW, Davis KB, Maynard C, Fritz JK, Kaiser G, et al. Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS). The Journal of thoracic and cardiovascular surgery 1982; 84 (3):334-341.
• 22. Briguori C, Tobis J, Nishida T, Vaghetti M, Albiero R, Di Mario C, et al. Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries. European heart journal 2002; 23 (3):247-254.
• 23. Mosseri M, Nahir M, Rozenman Y, Lotan C, Admon D, Raz I, et al. Diffuse narrowing of coronary arteries in diabetic patients: the earliest phase of coronary artery disease. Cardiology 1998; 89 (2):103-110.
• 24. Ertan C, Ozeke O, Gul M, Aras D, Topaloglu S, Kisacik HL, et al. Association of prediabetes with diffuse coronary narrowing and small-vessel disease. Journal of cardiology 2014; 63 (1):29-34.
• 25. 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. 2011; 22 (4):233-237.
• 26. Açar B, Ozeke O, Karakurt M, Ozen Y, Özbay MB, Unal S, et al. Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome. Angiology 2019; 70 (2):174-180.
• 27. Chung WK, Erion K, Florez JC, Hattersley AT, Hivert MF, Lee CG, et al. Precision medicine in diabetes: a Consensus Report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2020; 63 (9):1671-1693.
• 28. Papazafiropoulou AK, Patsourakos NG, Melidonis A. Prediabetes and Atherosclerotic Disease. Angiology 2019; 70 (2):101-102.
• 29. Balkau B. The DECODE study. Diabetes epidemiology: collaborative analysis of diagnostic criteria in Europe. Diabetes & metabolism 2000; 26 (4):282-286.
• 30. Ford ES, Zhao G, Li C. Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence. Journal of the American College of Cardiology 2010; 55 (13):1310-1317.
• 31. 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 (2):151-157.
• 32. de Vegt F, Dekker JM, Ruhé HG, Stehouwer CD, Nijpels G, Bouter LM, et al. Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study. Diabetologia 1999; 42 (8):926-931.
• 33. AbuShady MM, Mohamady Y, Enany B, Nammas W. Prevalence of prediabetes in patients with acute coronary syndrome: impact on in-hospital outcomes. Internal medicine journal 2015; 45 (2):183-188.
• 34. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. European journal of epidemiology 2013; 28 (2):169-180.
• 35. Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Kim S, et al. Outcomes in prediabetes vs. diabetes in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous intervention. Coronary artery disease 2021; 32 (3):211-223.
• 36. Cicek G, Uyarel H, Ergelen M, Ayhan E, Abanonu GB, Eren M, et al. Hemoglobin A1c as a prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. 2011; 22 (3):131-137.
• 37. Özen M, Serinken M, YILMAZ A, Özen ŞJTJoEM. Acil Servise Başvuran Akut Koroner Sendrom Tanılı Hastaların Sosyodemografık ve Klinik Özellikleri. 2012; 12 (3).
• 38. Özme CB. Normal koroner arterli hastalarda koroner arter çaplarının demografik veriler ile değişimi ve koroner arterler arasında çap ilişkilerinin incelenmesi. 2007.
• 39. 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. Circulation Heart failure 2016; 9 (1).
• 40. Kanaya AM, Herrington D, Vittinghoff E, Lin F, Bittner V, Cauley JA, et al. Impaired fasting glucose and cardiovascular outcomes in postmenopausal women with coronary artery disease. Annals of internal medicine 2005; 142 (10):813-820.
• 41. Vergès B, Zeller M, Dentan G, Beer JC, Laurent Y, Janin-Manificat L, et al. Impact of fasting glycemia on short-term prognosis after acute myocardial infarction. The Journal of clinical endocrinology and metabolism 2007; 92 (6):2136-2140.
• 42. Plantinga LC, Crews DC, Coresh J, Miller ER, 3rd, Saran R, Yee J, et al. Prevalence of chronic kidney disease in US adults with undiagnosed diabetes or prediabetes. Clinical journal of the American Society of Nephrology : CJASN 2010; 5 (4):673-682.
• 43. 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 (London, England) 2002; 359 (9324):2140-2144.
• 44. Is the current definition for diabetes relevant to mortality risk from all causes and cardiovascular and noncardiovascular diseases? Diabetes care 2003; 26 (3):688-696.
• 45. Demirbağ R, Ekim H, Turan FJVTD. Koroner Arter Dominansı ve Qt Dispersiyonu. 8 (3):80-84.