Development of one-year major adverse cardiac events risk index in patients with acute coronary syndrome and diabetes mellitus who underwent percutaneous coronary intervention

Mirković, Marija; Nedeljković, Milan; Ružičić, Dušan; Vuković, Mira

doi:10.2298/VSP181102026M

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Vojnosanitetski pregled

2020, vol. 77, br. 11, str. 1192-1200

Razvoj indeksa rizika od velikih vaskularnih događaja tokom godinu dana posle perkutane koronarne intervencije kod bolesnika sa akutnim koronarnim sindromom i dijabetesom melitusom

Mirković Marija^a, Nedeljković Milan^b, Ružičić Dušan^a, Vuković Mira^a

^aGeneral Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Valjevo
^bKlinički centar Srbije, Klinika za kardiologiju, Beograd + Univerzitet u Beogradu, Medicinski fakultet

e-adresa: marijamirkovic58va@gmail.com

Ključne reči: koronarna bolest; angiografija koronarnih arterija; dijabetes melitus; komorbiditet; kardiovaskularne bolesti; akutna bolest; faktori rizika

Sažetak

Uvod/Cilj. Bolesnici sa akutnim koronarnim sindromom (AKS) i dijabetes melitusom (DM) imaju povećan rizik od pojave velikih neželjenih kardiovaskularnih događaja (VNKD) nakon perkutane koronarne intervencije (PKI), ali on je nedovoljno višedimenzionalno procenjen u odnosu na vrstu i težinu AKS i/ili DM i angiografske nalaze. Ova studija je imala za cilj da validira i razvije indeks metaboličkih, angiografsko-anatomskih i kliničkih faktora rizika za VNKD u toku jedne godine posle sprovedene PKI kod bolesnika sa AKS i DM. Metode. Sprovedena je prospektivna studija preseka kod bolesnika sa DM i AKS, kojima su u periodu PKI evidentirani sledeći faktori rizika: 1) metaboličke varijable - nivoi glikoziliranog hemoglobina (HbA1c), ukupnog holesterola i triglicerida u krvi; 2) endokrinološke varijable - terapija DM i tip DM; 3) modalitete AKS; 4) radiološke/anatomske varijable - SYNTAX skor i 5) kliničke varijable u modifikovanom starost, kreatinin, ejekciona funkcija (engl. age, creatinine, ejection fraction - ACEF) skoru. VNKD su evidentirani do godinu dana posle PKI. Rezultati. Nakon PKI, od konsekutivno uključenih 136 bolesnika, njih 55 razvilo je bar jedan VNKD u periodu praćenja od jedne godine. Konstruisan je visoko prediktivni indeks rizika kojim su procenjeni zasebni ili združeni rizici od VNKD (c statistika = 0,879) u studijskoj populaciji, a koji su definisani SYNTAX skorom > 21, modifikovanim ACEF skorom > 1,38, HbA1c ≥ 8%, trigliceridemijom ≥ 2,3 mmol/L kod bolesnika na insulinskoj terapiji, kao i modalitetom ACS - nestabilna angina pektoris. Konstruisani indeks rizika (IR) od VNKD (IRVNKD) imao je bolje prediktivne karakteristike u odnosu na SYNTAX skor (c statistika = 0,798), kao i ACEF skor. Zaključak. IRVNKD potencijalno može da ima veliku primenu u budućim istraživanjima faktora rizika od VNKD koji nastaju do jedne godine posle PKI kod bolesnika sa DM i AKS, jer se njime učinci ovih faktora višedimenzionalno validno i precizno mere.

Abstract

Background/Aim. 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 study was intended to validate and develop an index of metabolic, angiographic, anatomic and clinical risk factors for one-year MACE after conducted PCI in patients with ACS and DM. Methods. A prospective cross-sectional study was performed in patients with DM and ACS. In the PCI period the following risk factors were recorded: 1) age and metabolic variables - glycosylated hemoglobin (HbA1c), total cholesterol, and triglycerides levels in the blood; 2) endocrinological variables - DM therapy and type of DM; 3) ACS modality; 4) radiological/anatomical variable - SYNTAX score, and 5) clinical variables in modified age, creatinine, ejection fraction (ACEF) 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. A high predictive risk index was evaluated that assessed particular or associated risks for one-year MACE (c statistic = 0.879) in the study population, defined by: SYNTAX score > 21, modified ACEF score > 1.38, HbA1c ≥ 8%, triglyceridemia ≥ 2.3 mmol/L in patients with insulin therapy, and ACS modality - unstable angina pectoris. The constructed risk index for one-year MACE (MACERI) had better predictive characteristics than SYNTAX score (c statistic = 0.798), as well as ACF score (c statistic = 0.744). Conclusion. MACERI can potentially have great application in future risk factors studies for one-year MACE in patients with DM and ACS who underwent PCI, because with it the effects of these factors are measured multidimensionally at valid and accurate manner.

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O članku

jezik rada: engleski
vrsta rada: izvorni naučni članak
DOI: 10.2298/VSP181102026M
primljen: 02.11.2018.
revidiran: 16.02.2019.
prihvaćen: 22.02.2019.
objavljen onlajn: 15.03.2019.
objavljen u SCIndeksu: 11.12.2020.
metod recenzije: dvostruko anoniman

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