Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
The Predictors of Diabetes and Pre-Diabetes Incidentally Detected at the Time of Diagnosis of Acute Coronary Syndrome: A Cross-Sectional Study
Akut Koroner Sendrom Tanısı Sırasında Rastlantısal Olarak Saptanan Diyabet ve Prediyabetin Öngörücüleri: Bir Kesitsel Çalışma
Özlem ÖZBEKa , Mehmet Mustafa CANa
aHaseki Training and Research Hospital, Clinic of Cardiology, İstanbul, Türkiye
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(3):96-106
doi: 10.5336/cardiosci.2023-99957
Article Language: EN
Full Text
ABSTRACT
Objective: There is a strong relationship between diabetes mellitus (DM) and cardiovascular diseases-related mortality and morbidity. Patients with DM are more likely to have more serious cardiovascular diseases and have higher complication rates than nondiabetic individuals. We aimed to investigate the rates of DM and preDM that were detected incidentally at the time of index acute coronary syndrome (ACS) and the factors that could predict incidental DM and pre-DM. Also, to investigate the factors associated with major adverse cardiovascular events (MACE) due to ACS. Material and Methods: This retrospective study included 1,882 patients without known DM or pre-DM diagnoses who were hospitalized and treated for ACS. The patients were divided into the following three classes: non-DM (n=582), pre-DM (n=602), and undiagnosed DM (un-DM, n=698). Results: We found that higher age (p<0.001), female sex (p<0.001), higher body mass index (p<0.001), hyperlipidemia (p<0.001), previous peripheral artery disease (p=0.012), previous cerebrovascular disease (p=0.021), and renal diseases (p=0.017) were independently associated with pre-DM and un-DM. High age (p<0.001), renal diseases (p<0.001), ST-elevation myocardial infarction (p=0.008), un-DM (p<0.001), and pre-DM (p=0.044) were independently associated with an increased MACE risk, while hyperlipidemia (p<0.001) and antiaggregant use (p=0.012) were independently associated with a decreased MACE risk. Conclusion: The above-mentioned risk factors can be used to predict (pre)DM before ACS or to assess MACE risk after ACS. Such risk stratification may contribute to reducing cardiovascular mortality and morbidity that are increased by (pre)DM and MACE.

Keywords: Acute coronary syndrome; diabetes mellitus; major adverse cardiovascular events; pre-diabetes; ST-elevation myocardial infarction
ÖZET
Amaç: Diabetes mellitus (DM) ile kardiyovasküler hastalıklara bağlı mortalite ve morbidite arasında güçlü bir ilişki vardır. DM'li hastaların diyabetik olmayanlara göre daha ciddi kardiyovasküler hastalıklara yakalanma ve daha yüksek komplikasyon oranlarına sahip olma olasılığı daha yüksektir. Bu çalışmada, indeks akut koroner sendrom (AKS) sırasında rastlantısal olarak saptanan DM ve pre-DM oranlarını ve rastlantısal DM ve pre-DM'yi öngörebilecek faktörleri araştırmayı amaçladık. Ayrıca AKS'ye bağlı majör advers kardiyovasküler olaylar [major adverse cardiovascular events (MACE)] ile ilişkili faktörleri araştırdık. Gereç ve Yöntemler: Bu retrospektif çalışmaya, bilinen DM veya pre-DM tanıları olmayan ve AKS nedeniyle hastaneye yatırılarak tedavi edilen 1.882 hasta dâhil edildi. Hastalar şu 3 gruba ayrıldı: DM olmayan (n=582), pre-DM (n=602) ve tanı konmamış DM [undiagnosed DM (un-DM)] (n=698). Bulgular: İleri yaş (p<0,001), kadın cinsiyet (p<0,001), beden kitle indeksi artışı (p<0,001), hiperlipidemi (p<0,001), geçirilmiş periferik arter hastalığı (p=0,012), geçirilmiş serebrovasküler hastalık (p=0,021), böbrek hastalıklarının (p=0,017) preDM ve un-DM ile bağımsız olarak ilişkili olduğu bulunmuştur. İleri yaş (p<0,001), böbrek hastalıkları (p<0,001), ST elevasyonlu miyokard infarktüsü (p=0,008), un-DM (p<0,001) ve pre-DM (p=0,044) bağımsız olarak artmış MACE riski ile ilişkiliyken, hiperlipidemi (p<0,001) ve antiagregan kullanımı (p=0,012) bağımsız olarak azalmış MACE riski ile ilişkiliydi. Sonuç: Yukarıda belirtilen risk faktörleri AKS öncesinde (pre)DM ve AKS sonrasında MACE'yi öngörmek için kullanılabilir. Bu risk faktörleri kullanılarak yapılacak risk tabakalandırması, (pre)DM ve MACE ile artan kardiyovasküler mortalite ve morbiditenin azaltılmasına katkıda bulunabilir.

Anahtar Kelimeler: Akut koroner sendrom; diabetes mellitus; majör advers kardiyovasküler olay; prediyabet; ST elevasyonlu miyokard infarktüsü
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