Myocardial injury in diabetic patients with multivessel coronary artery disease after revascularization interventions
| Autor: | José Antonio Franchini Ramires, Roberto Kalil Filho, Rosa Maria Rahmi, D F C Azevedo, Thiago Luis Scudeler, Carlos Alexandre Segre, Cibele Larrosa Garzillo, Whady Hueb, Paulo Cury Rezende |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Endocrinology Diabetes and Metabolism medicine.medical_treatment Coronary artery bypass 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Revascularization Coronary artery disease Percutaneous coronary intervention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Diabetes mellitus Type 2 diabetes mellitus Internal Medicine medicine Myocardial infarction cardiovascular diseases lcsh:RC620-627 biology business.industry Research medicine.disease Troponin lcsh:Nutritional diseases. Deficiency diseases chemistry REVASCULARIZAÇÃO MIOCÁRDICA Conventional PCI biology.protein Cardiology Glycated hemoglobin business |
| Zdroj: | Diabetology & Metabolic Syndrome, Vol 9, Iss 1, Pp 1-9 (2017) Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual) Universidade de São Paulo (USP) instacron:USP Diabetology & Metabolic Syndrome |
| ISSN: | 1758-5996 |
| DOI: | 10.1186/s13098-017-0292-3 |
| Popis: | Background Diabetic patients may be more susceptible to myocardial injury after coronary interventions. Thus, the aim of this study was to assess the release of cardiac biomarkers, CK-MB and troponin, and the findings of new late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with type 2 diabetes mellitus after elective revascularization procedures for multivessel coronary artery disease (CAD). Methods Patients with multivessel CAD and preserved systolic ventricular function underwent either elective percutaneous coronary intervention (PCI), off-pump or on-pump bypass surgery (CABG). Troponin and CK-MB were systematically collected at baseline, 6, 12, 24, 36, 48 and 72 h after the procedures. CMR with LGE was performed before and after the interventions. Patients were stratified according to diabetes status at study entry. Biomarkers and CMR results were compared between diabetic and nondiabetics patients. Analyses of correlation were also performed among glycemic and glycated hemoglobin (A1c) levels and troponin and CK-MB peak levels. Patients were also stratified into tertiles of fasting glycemia and A1c levels and were compared in terms of periprocedural myocardial infarction (PMI) on CMR. Results Ninety (44.5%) of the 202 patients had diabetes mellitus at study entry. After interventions, median peak troponin was 2.18 (0.47, 5.14) and 2.24 (0.69, 5.42) ng/mL (P = 0.81), and median peak CK-MB was 14.1 (6.8, 31.7) and 14.0 (4.2, 29.8) ng/mL (P = 0.43), in diabetic and nondiabetic patients, respectively. The release of troponin and CK-MB over time was statistically similar in both groups and in the three treatments, besides PCI. New LGE on CMR indicated that new myocardial fibrosis was present in 18.9 and 17.3% (P = 0.91), and myocardial edema in 15.5 and 22.9% (P = 0.39) in diabetic and nondiabetic patients, respectively. The incidence of PMI in the glycemia tertiles was 17.9% versus 19.3% versus 18.7% (P = 0.98), and in the A1c tertiles was 19.1% versus 13.3% versus 22.2% (P = 0.88). Conclusions In this study, diabetes mellitus did not add risk of myocardial injury after revascularization interventions in patients with multivessel coronary artery disease. Trial Registration Name of Registry: Evaluation of cardiac biomarker elevation after percutaneous coronary intervention or coronary artery bypass graft; URL: http://www.controlled-trials.com.ISRCTN09454308 |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|