Medicinski Podmladak (Jan 2020)
Clinical characteristics and two-year outcome of patients with angina pectoris without obstructive coronary artery disease: Diabetics vs. non-diabetics
Abstract
Introduction: Myocardial ischemia, without significant stenosis on epicardial coronary arteries is still not fully explained entity, however coronary microcirculatory dysfunction is certainly important. This heterogeneous syndrome is referred to as INOCA (Ischemia with No Obstructive Coronary Artery Disease) and carries a significant risk of major cardiovascular events (Major Adverse Cardiovascular Events - MACE). Diabetes mellitus (DM) is a risk factor for coronary microcirculatory dysfunction, but its role in INOCA is not completely evaluated. Aim: To compare the clinical characteristics and outcomes during two-year follow-up in patients with INOCA with vs. without diabetes, referred to coronary angiography due to chest pain or angina pectoris. Material and methods: A number of 328 patients with angina and/or documented inducible ischemia referred for angiography to Cardiology department of Clinical Center of Serbia between June 2015 and June 2017 were included in study. All of data (clinical parameters, echocardiographic and angiographic results) are obtained from standard medical history and through a telephone survey. Mortality was defined as the primary endpoint and MACE (mortality, myocardial infarction and hospitalization because of heart failure) as the secondary endpoint. Results: Patients are divided into two groups: DM (n = 93; 28.4%) and nonDM. The follow-up was done in 124 patients. The median of follow-up was two years and mortality was 3%. All patients who died had DM. The incidence of hospitalization in the whole group was 47%, and the development of heart failure was 69%. Patients with DM were older (p = 0.001), had higher BMI (p = 0.028), higher incidence of valvular diseases and higher incidence of MACE (p < 0.05). Groups didn't significantly differ according to results of the exercise test, coronarographic findings, nor according to the clinical presentation and other risk factors. Conclusion: Patients with INOCA might have severe clinical outcomes (mortality, hospitalization, heart failure development). Diabetes mellitus is a significant predictor of an adverse clinical event among INOCA patients.
