微血管并发症与 2 型糖尿病和慢性闭塞中的冠状动脉侧支循环有关。

Microvascular Complications Are Associated With Coronary Collateralization in Type 2 Diabetes and Chronic Occlusion.

机构信息

Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.

Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

出版信息

J Clin Endocrinol Metab. 2023 Dec 21;109(1):237-244. doi: 10.1210/clinem/dgad396.

DOI:10.1210/clinem/dgad396

PMID:37417706

Abstract

CONTEXT

Coronary collateral (CC) vessel development appears to be protective with regard to adverse cardiovascular events and survival in patients with coronary chronic total occlusion (CTO). The influence of type 2 diabetes mellitus (T2DM) on CC growth has been controversial. In particular, the role of diabetic microvascular complications (DMC) in determining coronary collateralization has not been elucidated.

OBJECTIVE

To investigate whether patients with DMC presented differences in CC vessel presence and grading as compared with patients without DMC.

METHODS

We conducted a single-center observational study, including consecutive T2DM patients, without previous cardiovascular history, undergoing a clinically indicated coronary angiography for chronic coronary syndrome (CCS) and angiographic evidence of at least one CTO. Patients were subdivided into 2 study groups according to the presence/absence of at least one DMC (neuropathy, nephropathy, or retinopathy). The presence and grading of angiographically visible CC development from the patent vessels to the occluded artery were assessed using the Rentrop classification.

RESULTS

We enrolled 157 patients (mean age 68.6 ± 9.8 years; 120 [76.4%] men). Patients with DMC (75 [47.8%]) had a higher prevalence of CC (69 [92.0%] vs 62 [75.6%], P = .006) and high-grade CC (55 [73.3%] vs 39 [47.6%], P = .001) compared with those without, and we found a positive association between the number of DMC in each patient and the prevalence of high-grade CC.

CONCLUSION

Among T2DM patients with coronary CTO, the presence of DMC was associated with a high CC development.

摘要

背景

冠状动脉侧支（CC）血管的发展似乎对慢性冠状动脉完全闭塞（CTO）患者的不良心血管事件和生存具有保护作用。2 型糖尿病（T2DM）对 CC 生长的影响存在争议。特别是，糖尿病微血管并发症（DMC）在决定冠状动脉侧支循环中的作用尚未阐明。

目的

研究 DMC 患者与无 DMC 患者相比，CC 血管的存在和分级是否存在差异。

方法

我们进行了一项单中心观察性研究，纳入了连续的 T2DM 患者，这些患者没有先前的心血管病史，因慢性冠状动脉综合征（CCS）进行了临床指征明确的冠状动脉造影检查，并且存在至少一条 CTO 的血管造影证据。根据是否存在至少一种 DMC（神经病、肾病或视网膜病变），将患者分为 2 个研究组。使用 Rentrop 分级法评估从通畅血管到闭塞动脉的可见 CC 发育的存在和分级。

结果

我们纳入了 157 名患者（平均年龄 68.6±9.8 岁；120 名[76.4%]男性）。有 DMC（75 名[47.8%]）的患者 CC （69 名[92.0%]比 62 名[75.6%]，P=0.006）和高级 CC（55 名[73.3%]比 39 名[47.6%]，P=0.001）的发生率更高，我们发现每个患者 DMC 的数量与高级 CC 的发生率之间存在正相关。