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Uspešnost perkutanih koronarnih revaskularizacijskih posegov pri sladkornih bolnikih
Avtor: Blaž Mrevlje, Živa Pecan
Mentor: prof. dr. Igor Kranjec, dr. med
Izhodišca: Postopek koronarne revaskularizacije (PKRP) z vstavitvijo žilne opornice je v desetih letih uporabe postala ucinkovita metoda zdravljenja zoženih koronarnih arterij. Prednost te metode, pred ostalimi metodami PKRP, je zmanjšanje pogostnosti zgodnjih ishemicnih zapletov in zvecanje obstojnosti pridobljene žilne svetline. Podatki iz literature, o usodi sladkornih bolnikov po PKRP z vstavitvijo žilne opornice, so maloštevilni in nasprotujoci. V slovenskem prostoru še ni bilo raziskave, ki bi pokazala kakšna je usoda sladkornih bolnikov po vstavitvi koronarne žilne opornice.
Namen raziskave: V naši raziskavi želimo ugotoviti ali se sladkornim bolnikom godi po opravljenem PKRP z vstavitvijo žilne opornice slabše kot bolnikom brez sladkorne bolezni.
Bolniki in metode dela: Raziskava je bila retrospektivno-prospektivna. Vanjo smo vkljucili 363 bolnikov, ki jim je bil PKRP z vstavitvijo žilne opornice opravljen v kateterizacijskem laboratoriju Klinicnega oddelka za kardiologijo Klinicnega centra v Ljubljani, med aprilom 1995 in majem 1999. V študijsko skupino smo vkljucili 74 bolnikov s sladkorno boleznijo, v kontrolno skupino pa 289 bolnikov brez nje.
Demografske podatke obeh skupin in opis simptomov in znakov pred posegom smo dobili v bolniški dokumentaciji. Angiografske podatke pred posegom in neposredno po njem, opis revaskularizacijskega posega ter pogostnost periproceduralnih zapletov smo zajeli iz registra stentiranih bolnikov, ki nam je bil na voljo v kateterizacijskem laboratoriju. PKRP je bil angiografsko uspešen v primeru rezidualne stenoze manjše od 50 %. Med periproceduralne zaplete smo šteli miokardni infarkt (MI), nevarne prekatne motnje srcnega ritma, nenadno zaporo koronarne arterije, nujno perkutano ali kirurško revaskularizacijo tretirane koronarne arterije in morebitno smrt med hospitalnim zdravljenjem.
Podatke o simptomih v prvih šestih mesecih po revaskularizaciji smo pridobili s pisnim anketiranjem bolnikov. Klinicni kazalec restenoze je bila ponovitev enake ali hujše angine pektoris.
Koronarna angiografija je bila v prvih šestih mesecih po PKRP ponovljena pri 40 bolnikih, od tega pri 10 bolnikih študijske skupine in 30 bolnikih kontrolne skupine. Kontrolna koronarna angiografija je bila izvršena le v povezavi z resnimi ponovnimi simptomi. Angiografski kazalec restenoze je bila ponovna zožitev tretirane arterije na vec kot 50 %.
Rezultati: Uspešnost PKRP z vstavitvijo žilne opornice je bila pri študijski in kontrolni skupini enaka. Periproceduralni zapleti so bili v obeh skupinah enako pogosti (5,6 % vs. 6,7 %; p = NS). Najpogostejši zaplet v obeh skupinah je bil MI brez zobca Q (2,8 % vs. 3,1 %; p = NS). V prvih šestih mesecih po posegu smo pri študijski skupini zasledili vecji odstotek anginoznih bolecin, ki so lahko klinicni kazalec restenoze (70,2 % vs. 57,4 %; p < 0,05). S kontrolno koronarografijo smo ugotovili restenozo koronarne arterije pri 50 % bolnikov vsake skupine.
Zakljucki: Postopek PKRP z vstavitvijo žilne opornice je primarno enako uspešen tako pri sladkornih bolnikih kot pri bolnikih brez sladkorne bolezni. Periproceduralni zapleti so pri sladkornih bolnikih enako pogosti kot pri bolnikih brez sladkorne bolezni. V obdobju prve pol leta po opravljenem posegu se sladkornim bolnikov godi slabše zaradi pogostnejšega pojavljanja stenokardij. S kontrolno angiografijo smo ugotovili restenozo tretirane koronarne arterije pri polovici vsake skupine
[Abstract / English version]
Success rate of percutaneous coronary revascularization procedures in diabetic patients
Author: Blaž Mrevlje, Živa Pecan
Mentor: prof. dr. Igor Kranjec, dr. med
Points of departure: In the last ten years, percutaneous transluminal coronary angioplasty (PTCA) with stenting has become an effective method of stenosis treatment. The advantage of this method over other PTCA methods is the reduction of the frequency of early ishaemic complications and an increased life of the aquired lumen. Information on the outcome of diabetic patients following a PTCA with stenting is scarce and controversial. No studies showing the outcome of diabetic patients following stenting have been performed in Slovenia. Aim of the study: The present study aims at determining whether diabetic patients having undergone a PTCA with stenting are in a less favourable general condition than patients without diabetes.
Patients and methods of work: The study was retrospective-prospective. It covered 363 patients having undergone the PTCA with stenting at the catheterisation laboratory of the Clinical Dept. of Cardiology of the Clinical Centre in Ljubljana between April 1995 and May 1999. The study group comprised 74 diabetic patients, while the control group counted 289 patients who were not suffering from diabetes.Demographic data on both groups as well as pre-procedure symptom and sign descriptions were obtained from the register of stented patients made available to us at the catheterisation laboratory.Any PTCA with less than a 50 % residual stenosis of the treated artery following the procedure was deemed successful. The following were regarded as periprocedural complications: myocardial infarction (MI), perilous ventricular arrhythmia, sudden coronary artery closure, urgent percutaneous or surgical revascularisation of the treated coronary artery and death in the procedure-to-discharge period.Symptom data for the first six months following the procedure were obtained for 40 patients, 10 of which were from the study group and 30 from the control group. A control coronary angiography during the patient monitoring period was only carried out in relation to serious reoccurring symptoms. The angiographic indicator of restenosis was a more than 50 % stenosis of the treated artery.
Results: The success rate of PTCA with stenting was the same for both the study and control groups. Periprocedural complications were equally frequent in both groups (5.6 % vs. 6.7 %; NS). Non-Q MI was the most frequent complication in both groups (2.8 % vs. 3.1 %; NS). In the first six months following the procedure a higher frequency of anginous pains was determined, the latter being a clinical indicator of resthenosis (70.2 % vs. 57.4 %; p < 0,05). In each group, control angiography revealed restenosis in 50 % of patients.
Conclusions: PTCA with stenting is primarily equally successful in diabetic patients and in non-diabetic patients alike. Periprocedural complications are equally frequent for both diabetic and non-diabetic patients. In the first six months following the procedure, diabetic patients are in a generally less favourable condition.Control angiography detected restenosis in half of the patients in each examined group.