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Coronary collateral circulation is less developed when ischaemic heart disease coexists with diabetes
Krzysztof Rzeczuch1, Dariusz Jagielski, Adam Kołodziej
1Department of Cardiology, 4th Military Hospital, Wrocław, Poland.
Insights
Diabetic patients with ischemic heart disease exhibit poorer coronary collateral circulation development compared to non-diabetic individuals. This impaired collateral circulation in diabetes may contribute to worse outcomes after myocardial infarction.
Area of Science:
- Cardiology
- Diabetology
- Vascular Biology
Background:
- Coronary collateral circulation significantly influences outcomes after myocardial infarction (MI).
- Diabetes mellitus is associated with endothelial dysfunction, potentially impairing collateral development.
- Impaired coronary collateral circulation may exacerbate post-MI complications in diabetic patients.
Purpose of the Study:
- To compare the development of coronary collateral circulation in patients with advanced ischemic heart disease (IHD) with and without diabetes.
Main Methods:
- A study group of 70 diabetic patients with total coronary occlusion underwent coronary angiography.
- A control group of 70 non-diabetic patients, matched for age, gender, and MI history, was included.
- Coronary collateral circulation was quantified using the collateral score (CS).
Main Results:
- Diabetic patients showed significantly less developed collateral circulation (lower CS) compared to non-diabetic patients (1.47 vs. 2.03, p < 0.05).
- Collateral score (CS) was independently associated with the presence of diabetes and the number of affected coronary vessels.
- Diabetic patients presented with more advanced coronary atherosclerotic lesions.
Conclusions:
- Patients with IHD and diabetes have significantly impaired coronary collateral circulation compared to those without diabetes.
- The extent of coronary lesions does not fully explain the reduced collateralization in diabetic patients.
- Diabetes is an independent predictor of reduced coronary collateral circulation in patients with IHD.
Background:
The extent of myocardial ischaemia and the magnitude of systolic function impairment following myocardial infarction (MI) depend to a large degree on the performance of coronary collateral circulation. Endothelial function is altered in several disorders, including diabetes. An impaired development of coronary collateral circulation may be a factor responsible for post-MI complications in patients with diabetes.
Aim:
To compare the degree of coronary collateral circulation development between patients with advanced ischaemic heart disease (IHD), with or without diabetes.
Methods:
The study group consisted of 70 consecutive patients with diabetes who underwent coronary angiography between September 1998 and December 1999 and had total occlusion of at least one of the main coronary vessels. The control group consisted of 70 age-, gender, and MI history-matched non-diabetic patients. Coronary collateral circulation was assessed using the collateral score (CS).
Results:
Patients with diabetes had less developed coronary collateral circulation than the patients without diabetes which was reflected by a significantly lower CS value - 1.47+/-1.56 vs 2.03+/-1.81; p < 0.05. No significant relationship was found between CS and age, gender, body mass index, history of MI or the presence of IHD risk factors. There was a significant association between the number of vessels with lesions and CS: r=0.40, p=0.0006 in the control group and r=0.42, p=0.0003 in patients with diabetes. The CS values in patients with single-, two- or three-vessel disease were 1.27+/-1.34, 2.38+/-1.85 and 2.98+/-2.07 in the control group, and 0.70+/-0.90, 1.10+/-1.30 and 2.23+/-1.76 in patients with diabetes, respectively. A multivariate analysis revealed that the presence of diabetes (t=-3.04, p=0.003) and the number of affected vessels (t=5.23, p=0.0001) were independently related to the CS values.
Conclusions:
Patients with IHD and diabetes have less developed coronary collateral circulation than IHD patients without diabetes, regardless of the extent of coronary lesions. Patients with diabetes who undergo coronary angiography, have more advanced coronary atherosclerotic lesions than patients without diabetes.
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