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2013, vol. 19, br. 3-4, str. 71-80
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Infarkt miokarda u bolesnika sa dijabetes melitusom tip 2 - incidencija, kliničke i angiografske karakteristike
Myocardial infarction in patients with diabetes mellitus type 2: Incidence, clinical and angiographic characteristics
Sažetak
Uvod. Populaciona istraživanja su pokazala da je dijabetes melitus nezavisni faktor rizika za razvoj kardiovaskularnih bolesti. Procenjuje se da je učestalost ishemijske bolesti srca kod bolesnika sa dijabetesom tip 2 od 10% do 20%. Angiografske i obdukcijske studije su pokazale da bolesnici sa dijabetesom imaju veću učestalost višesudovne bolesti i veći broj i ekstenzivnije stenoze koronarnih arterija. Cilj rada. Cilj rada je da se ispitaju incidencija, kliničke i angiografske karakteristike infarkta miokarda u populaciji bolesnika sa dijabetes melitusom tip 2. Metod. Retrospektivnim ispitivanjem obuhvaćeno je 1.200 bolesnika sa dijabetes melitusom tip 2, 506 (42,2%) muškaraca i 694 (57,8%) žene. Kontrolnu grupu je činilo 1.246 konsekutivnih pacijenata bez dijabetesa, 550 (44,1%) muškaraca i 696 (55,9%) žena (p>0,05). Iz obe populacije izdvojena je grupa od 90 bolesnika sa infarktom miokarda, 50 bolesnika sa infarktom i dijabetesom i 40 bolesnika sa infarktom bez dijabetesa, kod kojih je urađena kateterizacija srca sa selektivnom koronarografijom. Rezultati. Prosečna starost bolesnika sa dijabetesom je 64,9±10,4 godine, a bolesnika bez dijabetesa 66,9±13,0 godina (p<0,001). Od 1.200 bolesnika sa dijabetesom, infarkt miokarda je imalo 115 (9,6%), a od 1.246 pacijenata kontrolne grupe bez dijabetesa - 50 (4,0%), (r<0,01). Od 506 muškaraca sa dijabetesom, sa infarktom miokarda je bilo 70 (13,8%), a od 694 žene sa dijabetesom - 45 (6,5%), (p<0,01). Od 550 muškaraca bez dijabetesa, sa infarktom miokarda je bilo 39 (7,1%), a od 696 žena bez dijabetesa - 11 (1,6%), (p<0,01). Postoji statistički značajno veća incidencija infarkta miokarda u muškaraca sa dijabetesom (13,8%) u odnosu na muškarce bez dijabetesa (7,1%), (r<0,01). Postoji statistički značajno veća incidencija infarkta u žena sa dijabetesom (6,5%) u odnosu na žene bez dijabetesa (1,6%), (p<0,01). Prednju lokalizaciju infarkta miokarda imalo je 58 (50,4%) bolesnika sa dijabetesom i 22 (44,0%) bez dijabetesa (p>0,05), a donju 41 (35,7%) bolesnik sa dijabetesom i 22 (44,0%) bez dijabetesa (p>0,05). Trosudovnu koronarnu bolest su imala 32/50 (64%) bolesnika sa dijabetesom i 13/40 (32,5%) bez dijabetesa (p<0,01), a višesudovnu bolest 43/50 (86,0%) bolesnika sa dijabetesom i 24/40 (60,0%) bez dijabetesa (r<0,01). Zaključak. Značajno veća incidencija infarkta miokarda u bolesnika sa dijabetesom u odnosu na bolesnike bez dijabetesa, ukazuje da je dijabetes melitus značajan faktor rizika za nastanak infarkta u ovih bolesnika. Bolesnici sa infarktom miokarda i dijabetesom imaju značajno češće trosudovnu i višesudovnu koronarnu bolest i veći broj stenoza i totalnih okluzija koronarnih arterija.
Abstract
Introduction. Population studies have shown that diabetes mellitus is an independent risk factor for cardiovascular disease. Incidence of ischemic heart disease in patients with type 2 diabetes is estimated at 10% to 20%. Angiographic and autopsy studies have shown that incidence of multi vessel disease is higher and coronary artery stenosis is more severe in patients with diabetes. Objective. The aim of the study was to examine the incidence, clinical and angiographic characteristics of myocardial infarction in patients with type 2 diabetes mellitus. Method. The retrospective study included 1200 patients with type 2 diabetes mellitus, 506 (42.2%) men and 694 (57.8%) women. The control group consisted of 1246 consecutive patients without diabetes, 550 (44.1%) men and 696 (55.9%) women (p> 0.05). From both groups, we separated 90 patients with myocardial infarction, 50 patients with ischemic stroke and diabetes and 40 patients with acute myocardial infarction without diabetes who underwent heart catheterization with selective coronary angiography. Results. The average age of patients with diabetes was 64.9 ± 10.4 years, and of patients without diabetes 66.9 ± 13.0 years (p<0.001). Myocardial infarction had 115 (9.6%) patients in the group with diabetes and 50 (4.0%) in the control group without diabetes (p <0.01). Myocardial infarction had 70 (13.8%) patients from the group of 506 male patients with diabetes, and 45 (6.5%) from the group of 694 women with diabetes (p <0.01). In the control group of 550 patients, myocardial infarction was found in 39 (7.1%) male, and 11 (1.6%) female patients without diabetes (p <0.01). Incidence of myocardial infarction was significantly higher in patients with diabetes than in those without diabetes, both in male (13.8% vs. 7.1%, p<0.01) and in female population (6.5% vs. 1.6%, p <0.01). Anterior localization of myocardial infarction was found in 58 (50.4%) patients with diabetes and 22 (44.0%) without diabetes (p> 0.05), and inferior localization in 41 (35.7%) patients with diabetes and 22 (44.0%) without diabetes (p> 0.05). Three-vessel disease had 32/50 (64%) patients with diabetes and 13/40 (32.5%) without diabetes (p <0.01). Multi vessel disease was found in 43/50 (86.0 %) patients with diabetes and 24/40 (60.0%) patients without diabetes (p<0.01). Conclusion. Significantly higher incidence of myocardial infarction in patients with diabetes compared to those without diabetes suggests that diabetes mellitus is an important risk factor for development of myocardial infarction. Three-vessel disease, multiple coronary stenosis, and total occlusion of the coronary artery are significantly more frequent in patients with myocardial infarction and diabetes.
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