Colaiori Iginio, Izzo Raffaele, Barbato Emanuele, Franco Danilo, Di Gioia Giuseppe, Rapacciuolo Antonio, Bartunek Jozef, Mancusi Costantino, Losi Maria Angela, Strisciuglio Teresa, Manzi Maria Virginia, de Simone Giovanni, Trimarco Bruno, Morisco Carmine
Cardiovascular Research Center Aalst OLV Hospital, 9300 Aalst, Belgium.
Department of Advanced Biomedical Sciences, University of Naples Federico II, 80100 Napoli, Italy.
J Clin Med. 2019 Jul 21;8(7):1069. doi: 10.3390/jcm8071069.
Cardio-vascular target organ damage predicts the onset of type 2 diabetes mellitus (DM) in hypertensive patients. Whether an increased incidence of DM is also in relation to the severity of coronary atherosclerosis is unknown.
We evaluated the onset of DM in relation to the extent and severity of coronary atherosclerosis, using the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score (SS), in patients with stable angina or acute coronary syndromes, referred for coronary angiography (CA).
Non-diabetic patients that underwent CA for the first time were included, and the SS was computed. Predictors of DM onset in low, medium, and high SSs were investigated.
Five hundred and seventy patients were included, and the mean SS was 6.3 ± 7.6. During a median follow-up of 79 months (interquartile range (IQR): 67-94), 74 patients (13%) developed DM. The risk of DM onset was significantly higher in the patients with a medium or high SS (hazard ratio (HR)-95% confidence interval (CI): 16 (4-61), < 0.0001; and 30 (9-105), < 0.0001, vs low SS, respectively), even after adjustment for obesity, history of hypertension, impaired fasting glucose, and cardiovascular therapy.
The severity and extent of the coronary atherosclerosis, evaluated by the SS, is a strong and independent predictor of the development of DM in patients, referred to CA.
心血管靶器官损害可预测高血压患者2型糖尿病（DM）的发病。DM发病率增加是否也与冠状动脉粥样硬化的严重程度有关尚不清楚。
我们使用SYNTAX（紫杉醇药物涂层支架与心脏外科手术协同作用）评分（SS），评估稳定型心绞痛或急性冠状动脉综合征患者行冠状动脉造影（CA）时，DM发病与冠状动脉粥样硬化程度和严重性的关系。
纳入首次接受CA的非糖尿病患者，并计算SS。研究低、中、高SS水平下DM发病的预测因素。
共纳入570例患者，平均SS为6.3±7.6。在中位随访79个月（四分位间距（IQR）：67 - 94）期间，74例患者（13%）发生DM。中、高SS水平患者DM发病风险显著更高（风险比（HR）- 95%置信区间（CI）：分别为16（4 - 61），<0.0001；和30（9 - 105），<0.0001，与低SS水平相比），即使在调整肥胖、高血压病史、空腹血糖受损和心血管治疗因素后仍如此。
通过SS评估的冠状动脉粥样硬化的严重程度和范围，是行CA患者发生DM的强有力且独立的预测因素。
