Kliničke karakteristike i dvogodišnji ishod bolesnika sa anginom pektoris bez opstruktivne koronarne bolesti: dijabetičari vs nedijabetičari - Lazović, Nevena (Medicinski podmladak, 2020)
KLINIČKE KARAKTERISTIKE I DVOGODIŠNJI ISHOD BOLESNIKA SA ANGINOM PEKTORIS BEZ OPSTRUKTIVNE KORONARNE BOLESTI: DIJABETIČARI VS NEDIJABETIČARI Uvod: Miokardna ishemija bez angiografski značajnih stenoza na epikardnim koronarnim arterijama predstavlja još uvek nedovoljno istražen entitet u čijem nastanku važnu ulogu sigurno ima disfunkcija koronarne mikrocirkulacije. Ovaj inače heterogeni sindrom je označen kao INOCA (Ischemia with No Obstructive Coronary Artery Disease) i nosi značajan rizik za nastanak značajnih kardiovaskularnih događaja (Major Adverse Cardiovascular Events - MACE). Dijabetes (DM) je faktor rizika za disfunkciju koronarne mikrocirkulacije, ali se ovaj entitet javlja i u osoba bez dijabetesa. Cilj rada: Uporediti kliničku sliku i dvogodišnji ishod pacijenata sa i bez dijabetesa upućenih na koronarografiju zbog angine pektoris na kojoj nisu utvrđene angiografski značajne stenoze na epikardnim koronarnim arterijama. Materijal i metode: Ispitivanje je obavljeno na Klinici za kardiologiju KCS u Beogradu na ukupno 328 pacijenata koji su se javili zbog anginoznog bola u grudima u periodu od juna 2015. do juna 2017. Podaci (klinički parametri, ehokardiografski i angiografski nalazi) su dobijeni iz standardnih istorija bolesti i putem telefonske ankete. Primarni ishod praćenja je mortalitet, a kao sekundarni su definisani kompozitni događaji u čiji sastav su ulazili: letalni ishod, infarkt miokarda i hospitalizacija zbog srčane insuficijencije. Rezultati: Bolesnici su podeljeni u dve grupe: DM (n=93, 28.4%) i neDM. Tokom dvogodišnjeg perioda praćenja obuhvaćeno je ukupno 123 pacijenata. Mortalitet je iznosio 3.2% i svi preminuli su bili dijabetičari. Incidencija hospitalizacije zbog kardiološkog događaja, u celoj grupi, iznosila je 55.2%, a razvoja srčane slabosti 69.7%. Pacijenti sa DM su imali veću prosečnu starost (p=0.001), veći BMI (p=0.028), veću učestalost valvularnih mana i veću učestalost MACE-a (p<0.05). Grupe se nisu statistički značajno razlikovale prema rezultatima testa fizičkim opterećenjem, koronarografskim nalazima, kao ni prema kliničkoj prezentaciji i drugim faktorima rizika. Zaključak: Pacijenti sa INOCA sindromom imaju ozbiljan klinički tok bolesti (hospitalizacije, srčana insuficijencija, smrtni ishod). Dijabetes melitus predstavlja značajan prediktor lošeg ishoda. Ključne reči: koronarna mikrovaskularna disfunkcija, dijabetes, INOCA, MACE CLINICAL CHARACTERISTICS AND TWO-YEAR OUTCOME OF PATIENTS WITH ANGINA PECTORIS WITHOUT OBSTRUCTIVE CORONARY ARTERY DISEASE: DIABETICS VS NON-DIABETICS Introduction: Myocardial ischemia, without significant stenosis on epicardial coronary arteries is still not fully explained entity, however coronary microcirculatory dysfunction is certainly important. This heterogeneous syndrome is referred to as INOCA (Ischemia with No Obstructive Coronary Artery Disease) and carries a significant risk of major cardiovascular events (Major Adverse Cardiovascular Events - MACE). Diabetes mellitus (DM) is a risk factor for coronary microcirculatory dysfunction, but its role in INOCA is not completely evaluated. The Aim: To compare the clinical characteristics and outcomes during two-year follow-up in patients with INOCA with vs without diabetes, conducted to coronary angiography due to chest pain or angina pectoris. Material and Methods: 328 patients with angina and/ or documented inducible ischemia referred for angiography to Cardiology department of Clinical Center of Serbia between June 2015. and June 2017., were included in study. Data (clinical parameters, echocardiographic and angiographic results) are obtained from standard medical history and through a telephone survey. Mortality was defined as the primary endpoint and MACE (mortality, myocardial infarction and hospitalization because of heart failure) as the secondary endpoint. Results: Patients are divided into two groups: DM (n=93, 28.4%) and nonDM. In 123 patients the follow-up was done. The median of follow-up was two years and mortality was 3.2%. All patients who died had DM. The incidence of hospitalization in the whole group was 55.2%, and the development of heart failure was 69.7%. Patients with DM were older (p = 0.001), had higher BMI (p = 0.028), higher incidence of valvular diseases and higher incidence of MACE (p<0.05). Groups didn’t significantly differ according to results of the exercise test, coronarographic findings, nor according to the clinical presentation and other risk factors. Conclusion: Patients with INOCA might have severe clinical outcomes (mortality, hospitalization, heart failure development). DM is a significant predictor of an adverse clinical event among INOCA patients. Keywords: coronary microvascular dysfunction; diabetes; INOCA; MACE