الفهرس 
Coronary Heart Disease in Diabetic patientsOnly 14 pages are availabe for public view
 |  | from | 201 |  |  |
| | | from | 201 | | |
Abstract
This was a prospective observational study conducted on 100 patients, to assess the mid and short-term clinical outcomes in diabetic patients (DM) with stable coronary artery disease (CAD), treated with 2nd generation Drug Eluting Stents (DES). A total of 100 DM-CAD patients, recruited from the department of cardiology, Tanta University Hospitals. The duration of the study was one year. At least, 100 patients included in this study. Patients were subjected to full medical history, general and cardiac examinations, investigations, ECG, and standard transthoracic Echocardiography (TTE). Follow up data will be obtained according to MACE (major adverse cardiac events) criteria including: death, myocardial infarction (STEMI and NSTEMI), cerebrovascular stroke, in-stent restenosis, stent thrombosis, and target lesion revascularization. Regarding baseline data, we found that; the mean age of all patients was (57.96 ± 8.32) years. Regarding gender of the patients, the majority (64%) of patients were males; while (36%) were females, with (36%) of patients had positive family history. We found that; the mean BMI of all patients was (30.7 ± 4.6). Regarding risk factors and co-morbidities, (58%) of patients were smokers, and (64%) had HTN. We also found that; the mean creatinine of all patients was (1.06 ± 0.24) mg/dl. Regarding ECG abnormalities, (90%) of patients had abnormal ECG findings, with (64%) had inverted T wave, (10%) had ST depression, (6%) had pathological Q, and (22%) had LBBB. Summary & Conclusion 136 We also found that; the mean EF of all patients was (60.5 ± 10.7%); with (72%) of patients had RWMA, (54%) of patients had LVH. Regarding grades of DD, (84%) of patients had grade I DD, and (16%) had grade II DD. Regarding valve abnormalities, (9%) of patients had mild MR, and (8%) had mild TR. We also found that; the average number of affected coronaries was (1.6 ± 0.7); with LAD affected in (68%) of patients, LCX in (34%), and RCA in (58%). Regarding interventional data, we found that; (6%) of patients had prior PCI, (10%) had prior CABG, and (10%) used GIIb/IIIa inhibitors. We also found that; the average number of treated coronaries was (1.3 ± 0.5); while the average total stented length was (48.6 ± 26.2) (mm). Regarding mid and short-term follow up or outcome data, we found that; the prevalence of MACE events was (68%), with mortality rate of (2%), and (6%) had NSTEMI, (12%) had IRS, (2%) had stent thrombosis, and (6%) had target lesion revascularization. The 100 DM-CAD patients were further classified according to MACE outcome into 2 independent groups: MACE group of (18 patients) and normal group of (82 patients). Comparative studies between the 2 groups revealed the following: • Non-significant difference as regards age, sex and family history (p > 0.05). • Non-significant difference as regards height, weight, BMI, HTN and smoking (p > 0.05) • Significant increase in inverted T wave in MACE group; compared to normal group; with significant statistical difference (p = 0.015) • Non-significant difference as regards creatinine, ST elevation, ST depression, pathological Q, LBBB and RBBB (p > 0.05). • Highly significant decrease in EF in MACE group; compared to normal group; with highly significant statistical difference (p < 0.01). • Non-significant difference as regards RWMA, LVH, and grades of DD (p > 0.05). • Non-significant difference as regards LM, LAD, and LCX affection (p > 0.05). • Highly significant increase in GIIb/IIIa inhibitors usage, in MACE group; compared to normal group; with highly significant statistical difference (p < 0.05). • Highly significant increase in syntax score, in MACE group; compared to normal group; with highly significant statistical difference (p < 0.05). • Non-significant difference as regards number of treated coronaries, total stented length, prior PCI, and CABG interventions (p > 0.05). Correlation studies between different MACE outcomes; and its relative independent predictors (baseline clinical, laboratory, echocardiographic, coronary, and interventional variables) revealed the following results: • The increase in positive family history, RCA affection, GIIb/IIIa inhibitors usage; and the decrease in baseline EF; had an independent effect on increasing the probability of MACE occurrence; with significant statistical difference (p < 0.05 respectively). By using ROC-curve analysis, G2-DES usage, predicted patients with MACE from patients without, with good accuracy, sensitivity= 73% and specificity= 100% (p < 0.01). To conclude, diabetes mellitus is a condition in which the use of 2nd generation zotarolimus-eluting stents is preferable, in order to reduce the incidence of MACE adverse events.