Factors of unfavorable prognosis of endovascular interventions in patients with dysfunctional myocardium and concomitant diabetes mellitus type 2

Abstract

Aim. Study of the features of endovascular intervention, correction of the lipid and carbohydrate metabolism as well as the role of myocardial visualization methods and their effect on delayed results of treatment of patients with left ventricular dysfunctional myocardium and concomitant diabetes mellitus. 
 Methods. The analysis of the treatment results of patients with dysfunctional myocardium and concomitant diabetes mellitus type 2 was performed. The analysis included 112 patients. The comparison group included 102 patients without diabetes. Visualization of postinfarction myocardial changes was performed with the use of magnetic resinance imaging of the heart both before and after the assessment of the delayed results. 
 Results. After 18-months follow-up mortality from cardiovascular comlications as well as the rate of major cardiac events was similar to that among patients without diabetes (1.8 and 1%; 6.25 and 3.92%, respectively). The similar tendency was observed 24 months after the intervention (3.3 and 2.3%; 9.8 and 5.7%, respectively). Among the factors associated with the development of such complications are preoperative values of glycosylated hemoglobin ≥6.5%, fasting plasm level of glucose ≥6.0 mmol/l, total cholesterol ≥5.2%, triglycerides ≥1,7 mmol/l, low-density lipoproteins ≥2.5 mmol/l. Also percutaneous coronary intervention later than 30 days after the myocardial infarction and incomplete myocardial revascularization, SYNTAX score >25, transmurality index ≥0.45, cardiac fibrosis ≥45% and presence of diabetes mellitus were prognostically unfavorable risk factors of cardiovascular events. 
 Conclusion. In patients with left ventricular dysfunctional myocardium and concomitant diabetes mellitus higher efficacy of endivascular intervention was observed and the prevalence of major cardiac events was camparable to the patients without diabetes; delayed percutaneous coronary intervention, incomplete myocardial revascularization, high indices of transmurality and cardiac fibrosis are prognostically unfavorable risk factors of cardiovascular events.