Teragawa Hiroki, Uchimura Yuko, Oshita Chikage, Hashimoto Yu, Nomura Shuichi
Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima, Japan.
Diabetes Metab Syndr Obes. 2024 May 25;17:2135-2146. doi: 10.2147/DMSO.S462234. eCollection 2024.
The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated whether they differ based on the presence or absence of DM in patients with VSA.
We included 272 Japanese patients with VSA diagnosed by coronary angiography (CAG) and the spasm provocation test (SPT). The diagnosis of DM was determined by measuring fasting blood glucose and hemoglobin A1C and by the patient's current oral medications. On CAG, the presence of atherosclerotic lesions (20%-50%) was checked. On SPT, the coronary spasm was defined as transient coronary vasoconstriction >90% on CAG, accompanied by chest symptoms and/or ST-T changes. Focal spasm was defined as coronary spasm occurring within one segment of the American Heart Association classification on CAG. Blood and urine tests and vascular endothelial function were also evaluated when possible. A major adverse cardiovascular event (MACE), which is defined as cardiac mortality and rehospitalization due to cardiovascular illness, was the basis for determining the prognosis.
There were 49 patients (18%) in the DM group and 223 (82%) in the non-DM group. No significant differences in urinary albumin levels and peripheral vascular function were between groups. On CAG, atherosclerotic lesions were observed significantly more frequently in the DM group (63% vs 46%; P = 0.028). Results of SPT showed a trend toward fewer focal spasms in the DM group (24% vs 39%; P = 0.072). No significant differences in MACE were noted between groups in the primary analysis of DM, whereas sub-analyses of focal spasms showed lower MACE-free survival in the DM group (P = 0.042).
The study results support the hypothesis that DM associated with VSA should be treated appropriately, especially in cases of focal spasm, which may require more attention in treatment.
糖尿病（DM）对变异性心绞痛（VSA）的临床背景及预后影响尚不清楚；因此，在这项回顾性研究中，我们调查了VSA患者中DM的有无是否会导致差异。
我们纳入了272例经冠状动脉造影（CAG）和痉挛激发试验（SPT）诊断为VSA的日本患者。通过测量空腹血糖和糖化血红蛋白A1C以及患者目前的口服药物来确定DM的诊断。在CAG检查中，检查动脉粥样硬化病变（20%-50%）的存在情况。在SPT中，冠状动脉痉挛定义为CAG上短暂性冠状动脉血管收缩>90%，伴有胸部症状和/或ST-T改变。局灶性痉挛定义为CAG上美国心脏协会分类的一个节段内发生的冠状动脉痉挛。还尽可能评估了血液和尿液检查以及血管内皮功能。主要不良心血管事件（MACE）定义为心脏死亡和因心血管疾病再次住院，是判断预后的依据。
DM组有49例患者（18%），非DM组有223例患者（82%）。两组间尿白蛋白水平和外周血管功能无显著差异。在CAG检查中，DM组动脉粥样硬化病变的观察频率显著更高（63%对46%；P=0.028）。SPT结果显示DM组局灶性痉挛有减少趋势（24%对39%；P=0.072）。在DM的初步分析中，两组间MACE无显著差异，而局灶性痉挛的亚分析显示DM组无MACE生存较低（P=0.042）。
研究结果支持以下假设，即与VSA相关的DM应得到适当治疗，尤其是在局灶性痉挛的情况下，治疗中可能需要更多关注。
