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2012, vol. 18, br. 3-4, str. 84-94
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Uticaj dijabetes melitusa na mortalitet, kliničke i angiografske karakteristike bolesnika sa ishemijskom kardiomiopatijom i srčanom insuficijencijom
Influence of diabetes mellitus on mortality, clinical and angiographic characteristics of patients with ischemic cardiomyopathy and heart failure
Sažetak
Uvod. U nekoliko studija je jasno identifikovan dijabetes melitus kao nezavisni prediktor kardiovaskularnog mortaliteta bolesnika sa ishemijskom bolešću srca i povećane smrtnosti u bolesnika sa srčanom insuficijencijom. Cilj rada. Cilj rada je bio da se ispita uticaj dijabetes melitusa na mortalitet, kliničke i angiografske karakteristike bolesnika sa ishemijskom kardiomiopatijom i srčanom insuficijencijom. Metod. Ispitivanjem je obuhvaćeno 50 bolesnika sa ishemijskom kardiomiopatijom i srčanom insuficijencijom, 42 (84,0%) muškarca i 8 (16,0%) žena, prosečne starosti 60,9±8,2 godine. Dijagnoza ishemijske kardiomiopatije i prisustvo srčane insuficijencije postavljeni su na osnovu kliničkih, elektrokardiografskih, radioloških i ehokardiografskih kriterijuma, kao i kompletnog hemodinamskog ispitivanja - kateterizacije srca sa selektivnom koronarografijom. Rezultati. Prosečna dužina praćenja svih bolesnika bila je 37,4±17,5 meseci (3,1 godina). Od ukupno 50 bolesnika, u posmatranom periodu praćenja umrlo je 28/50 (56,0%), sa godišnjom smrtnošću od 18,0%. Od 38 bolesnika sa dijabetesom, u toku 3,1 godine praćenja umrlo je 26/38 (68,4%), što predstavlja godišnji mortalitet od 22,0%. Od 12/50 (34,0%) bolesnika bez dijabetesa u istom periodu praćenja umrla su 2/12 (16,7%) ili 5,3% godišnje. Postoji statistički značajno veći mortalitet bolesnika sa ishemijskom kardiomiopatijom i srčanom insuficijencijom sa dijabetesom, u odnosu na bolesnike bez dijabetesa (χ²=16,0; r<0,01). Ukupni mortalitet bolesnika sa ishemijskom kardiomiopatijom i srčanom insuficijencijom koji su prethodno bili podvrgnuti hirurškoj revaskularizaciji bio je 20/30 (66,7%), bolesnika podvrgnutih PCI-stentu 4/12 (33,3%) i bolesnika na medikamentnoj terapiji 4/8 (50,0%). Prosečan godišnji mortalitet bolesnika lečenih sa CABG bio je 21,3%, bolesnika lečenih PCI-stentom 10,7% i bolesnika na medikamentnoj terapiji 16,1%. Postoji statistički značajno veći mortalitet bolesnika lečenih hirurškom revaskularizacijom miokarda u odnosu na mortalitet bolesnika lečenih perkutanom koronarnom intervencijom sa ugradnjom stentova (χ²=4,28; p<0,05). Ne postoji značajna razlika u mortalitetu između bolesnika lečenih sa CABG i bolesnika lečenih sa PCI-stentom i na medikamentnoj terapiji posmatrano skupno (χ²=3,67; p>0,05). Zaključak. Mortalitet bolesnika sa ishemijskom kardiomiopatijom i srčanom insuficijencijom sa dijabetesom bio je značajno veći od mortaliteta bolesnika bez dijabetesa, što ukazuje da je dijabetes melitus značajan nezavisni prediktor povećanog mortaliteta ovih bolesnika.
Abstract
Introduction. Several studies have clearly identified diabetes mellitus as an independent predictor of cardiovascular mortality in patients with ischemic heart disease, and of increased mortality in patients with heart failure. Objective. The aim of this study was to investigate the influence of diabetes mellitus on mortality, clinical and angiographic characteristics of patients with ischemic cardiomyopathy and heart failure Method. We examined 50 patients with ischemic cardiomyopathy and heart failure, 42 (84.0%) men and 8 (16.0%) women, mean age 60.9 ± 8.2 years. Diagnoses of ischemic cardiomyopathy and heart failure were based on the clinical, electrocardiographic, radiological and echocardiographic criteria and complete hemodynamic tests - cardiac catheterization with selective coronary angiography. Results. The average follow-up of all patients was 37.4 ± 17.5 months (3.1 years). During the follow-up period, 28 patients (56.0%) patients died. Annual mortality rate was 18.0%. Of 38 patients with diabetes, 26 (68.4%) died during the follow up period, representing annual mortality rate of 22.0%. In the same period 2 (16.7%) of 12 patients without diabetes have died, or 5.3% annually. Mortality rate was significantly higher in diabetic patients with ischemic cardiomyopathy and heart failure, compared to patients with ischemic cardiomyopathy and heart failure, but without diabetes (χ²=16,0 p<0,01). The overall mortality rate of patients with history of surgical revascularization (CABG) was 20/30 (66,7%), of patients undergoing percutaneous coronary intervention (PCI) 4/12 (33,3%) and of patients on medical therapy 4/8 (50,0%). Average annual mortality of patients treated with CABG was 21,3% of patients treated with PCI/stent 10,7% and of patients on medical therapy 16,1%. There was a statistically significant higher mortality in patients treated with CABG compared to the mortality of patients treated with percutaneous coronary intervention with stent implantation (χ²=4,28; p<0,05). There is no significant difference in mortality between patients treated with CABG and PCI patients treated with stent or drug therapy and the observed group (χ²=3,67 p>0,05). Conclusion. Mortality rate of patients with ischemic cardiomyopathy and heart failure was significantly higher in the group with associated diabetes, than in the group without diabetes, suggesting that diabetes mellitus is the significant independent risk factor for increased mortality rate of these patients.
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