ADVANCED MYOCARDIAL ISCHEMIA IN PATIENTS WITH DIABETES MELLITUS – EARLY RESULTS OF SURGICAL TREATMENT
Autori:
Bojan Štambuk, Željko Sutlić, Bojan Biočina, Igor Rudež, Davor Barić, Daniel Unić, Kristina Brkić
Sažetak
Sažetak. Retrospektivna studija provedena u razdoblju od 12/1997. do 12/2002. godine obuhvatila je 272 koronama bolesnika sa šećernom bolešću podvrgnuta kirurškoj revaskularizaciji miokarda: 80 bolesnika podvrgnutih totalnoj arterij skoj revaskularizaciji (DM-ART) i 192 bolesnika podvrgnuta revaskularizaciji uz primjenu vensko-arterijske premosnice (DM-NEART). Prijeoperacijski su analizirani demografski podaci i čimbenici rizika: arterij ska hipertenzija, hiperlipopreteinemija, proširenost koroname bolesti, stenoza debla lijeve koronarne arterije, nestabilna angina pektoris, prijeoperacij ski infarkt miokarda (INI), prethodni kardiokirurški zahvati, ejekcij ska frakcija, EuroScore. Tijekom 30-dnevnoga poslijeoperacij skog razdoblja praćeni su: krvarenje, perioperacij ski INI, infekcija rane, dehiscencija stemuma, perioperacij ski cerebrovaskulami inzult, smrt. Skupina DM-ART pokazala je značajno učestaliju hiperlipoproteinemiju (p=0,004). Značajna razlika uočena je u skupini DM-NEART samo za pojavu perioperacij skog IM (p<0,001). Totalna arterij ska revaskularizacija miokarda bez uporabe stroja za izvantjelesni krvotok potpuno je siguran izbor kod dijabetičkih bolesnika bez obzira na tip šećerne bolesti. Međutim, konačni zaključci mogu se donijeti tek na osnovi sveobuhvatne analize petogodišnjeg odnosno destogodišnjega poslijeoperacijskog pobola i smrtnosti.
Summary
Summary. In this restrospetive study, data on 272 coronary artery disease patients with concomitant diabetes mellitus treated between 12/1997 and 12/2002 were analyzed. Eighty patients inderwent complete arterial revascularization (DM-ART), whereas 192 patients underwent coronary revascularization using arterial-venous grafts (DN-NEART). The following preoperative data and risk factors were analyzed: arterial hypertension, hyperlipoproteinemia, number of vessels involved, left coronary artery stenosis, unstable angina, previous myocardial infarction (MI), previous cardiac surgery, EuroScore. During a 30-day postope- rative period, the following complications were analyzed: bleeding, perioperative MI, wound infection, sternal dehiscence, neurologic dysfunction, mortality. DM-ART patients had a higher rate of hyperlipoproteinemia (p=0.004). Difference was only found for the occurrence of perioperative MI in DM-NEART group (p<0.001). Total arterial revascularization without cardiopul- monary bypass is a reliable and safe choice in patients with concomitant diabetes mellitus irrespective of its type. Definitive conclusions can only be made after five- or ten-year evaluation of postoperative mirbidity and mortality.
