Dogot Marta*, Grib Andrei, Popa Ana, Grosu Mihaela, Smolenschi Iulia, Ion Sîrbu, Corlăteanu Olga and Caproș Natalia

Dogot Marta, State University of Medicine and Pharmacy “Nicolae Testemiţanu”, Chișinău, Republic of Moldova.

*Corresponding Author: Agron M Rexhepi, Institute of Sports Anthropology, Rr. Sali Butka Nr, Prishtina, Kosovo.

Received: April 18, 2022; Published: June 09, 2022

Abstract

Background: Despite increased attention to more intensive medical therapy for patients with established coronary artery disease (CAD), the presence of type 2 diabetes mellitus (T2DM) is associated with extended vascular atherosclerotic lesions in sites unrelated to the revascularized segment leading to an increased tendency to postrevascularization target and nontarget vessel ischemic events.

Material and Methods: We report a case of a 66-year-old man with insulin dependent type 2 diabetes patient who has been admitted to the emergency department for an ischemic event: atypical chest pain after physical exertion.

The Aim of the Study: to evaluate the risk factors associated with repeat revascularization within 7 years of first percutaneous coronary intervention (PCI) in a diabetic patient.

Results: On initial evaluation the patient presented with the symptoms of atypical chest pain, confined in the epigastrium, dyspnea. The physical findings of the patient: atrial fibrillation, hypotension, type 2 diabetes with macro- and microangiopathy, chronic kidney disease (CKD), hyperlipidemia, previous revascularization by PCI were revealed. The recent coronary angiography showed multivessel atherosclerotic lesions in sites unrelated to the previously revascularized segments.

Conclusion: The obtained data suggest that the factors associated with repeat revascularization within 7 years of first percutaneous coronary intervention of the presented case are uncontrolled type 2 diabetes mellutis, CKD, dyslipidemia and the progression of atherosclerosis with the involvement of multivessel legions.

Keywords: Coronary Angiography; Percutaneous Coronary Intervention; Repeat Revascularization; Diabetes Mellitus

References

1. Konigstein M., et al. “Outcomes among diabetic patients undergoing percutaneous coronary intervention with contemporary drug-eluting stents: analysis from the BIONICS randomized trial”. JACC: Cardiovascular Interventions 11 (2018): 2467-2476.
2. Barsness GW., et al. “Integrated management of patients with diabetes mellitus and ischemic heart disease: PCI, CABG, and medical therapy”. Current Problems in Cardiology 30 (2005): 583-617.
3. Nicholls SJ., et al. “Effect of diabetes on progression of coronary atherosclerosis and arterial remodeling: a pooled analysis of 5 intravascular ultrasound trials”. Journal of the American College of Cardiology 52 (2008): 255-262.
4. Frye RL., et al. “A randomized trial of therapies for type 2 diabetes and coronary artery disease”. The New England Journal of Medicine 360 (2009): 2503-2515.
5. Brooks MM., et al. “Clinical and angiographic risk stratification and differential impact on treatment outcomes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial”. Circulation 126 (2012): 2115-2124.
6. Patel MR., et al. “ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 appropriate use criteria for coronary revascularization in patients with acute coronary syndromes: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons”. Journal of the American College of Cardiology 69 (2017): 570-591.
7. Zhao XQ., et al. “Prediction of native coronary artery disease progression following PTCA or CABG in the Emory Angioplasty Versus Surgery Trial”. Medical Science Monitor 9 (2003): CR48-CR54.
8. Ryan J., et al. “Temporal changes in coronary revascularization procedures, outcomes, and costs in the bare-metal stent and drug-eluting stent eras: results from the US Medicare program”. Circulation 119 (2009): 952-961.
9. Stolker JM., et al. “Repeat revascularization after contemporary percutaneous coronary intervention: an evaluation of staged, target lesion, and other unplanned revascularization procedures during the first year”. Circulation: Cardiovascular Interventions 6 (2012): 772-782.
10. Norhammar A., et al. “Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization”. Journal of the American College of Cardiology 43 (2004): 585-591.
11. Alabas OA., et al. “Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study”. Journal of Epidemiology Community Health 71 (2017): 25-32.
12. Thygesen K., et al. “Fourth universal definition of myocardial infarction (2018)”. European Heart Journal 40 (2019): 237-269.
13. Reynolds HR., et al. “Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease”. Circulation 124 (2011): 1414-1425.
14. Chapman AR., et al. “Long-term outcomes in patients with type 2 myocardial infarction and myocardial injury”. Circulation 137 (2018): 1236-1245.
15. Nestelberger T., et al. “Effect of definition on incidence and prognosis of type 2 myocardial infarction”. Journal of the American College of Cardiology 70 (2017): 1558-1568.
16. Patsouras A., et al. “Screening and risk assessment of coronary artery disease in patients with type 2 diabetes: an updated review”. In vivo 33 (2019): 1039-1049.
17. Poznyak A., et al. “The diabetes mellitus-atherosclerosis connection: the role of lipid and glucose metabolism and chronic inflammation”. International Journal of Molecular Sciences 21 (2020): 1835.
18. La Sala L., et al. “The link between diabetes and atherosclerosis”. European Journal of Preventive Cardiology 26 (2019): 15-24.
19. Dai X., et al. “Reassessing coronary artery bypass surgery versus percutaneous coronary intervention in patients with type 2 diabetes mellitus: a brief updated analytical report (2015-2017)”. Diabetes Therapy 9 (2018): 2163-2171.
20. Kogan A., et al. “Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery”. Cardiovascular Diabetology 17 (2018): 151.
21. Godoy LC., et al. “The role of coronary artery bypass surgery versus percutaneous intervention in patients with diabetes and coronary artery disease”. Progress in Cardiovascular Diseases 62 (2019): 358-363.
22. Al-Jarallah M., et al. “Impact of diabetes on mortality and rehospitalization in acute heart failure patients stratified by ejection fraction”. ESC Heart Failure 7 (2020): 297-305.
23. Kang SM., et al. “Effects of anagliptin on the stress induced accelerated senescence of human umbilical vein endothelial cells”. Annals of Translational Medicine's 9 (2021): 750.
24. Icks A., et al. “Mortality after first myocardial infarction in diabetic and non-diabetic people between 1985 and 2009. The MONICA/KORA registry”. European Journal of Epidemiology 29 (2014): 899-909.
25. Chichareon P., et al. “Association of diabetes with outcomes in patients undergoing contemporary percutaneous coronary intervention: pre-specified subgroup analysis from the randomized GLOBAL LEADERS study”. Atherosclerosis 295 (2020): 45-53.
26. Yue Z., et al. “Effect of dapagliflozin on diabetic patients with cardiovascular disease via MAPK signalling pathway”. Journal of Cellular and Molecular Medicine 25 (2021): 7500-7512.
27. Wang H., et al. “Ten-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting for patients with type 2 diabetes mellitus suffering from left main coronary disease: a meta-analysis”. Diabetes Therapy 12 (2021): 1041-1054.
28. Investigators B. “The final 10-year follow-up results from the BARI randomized trial”. Journal of the American College of Cardiology 49 (2007): 1600-1606.
29. Liang B., et al. “Reassessing Revascularization. Strategies in Coronary Artery Disease and Type 2 Diabetes Mellitus”. Frontiers in Cardiovascular Medicine 8 (2021): 738620.
30. Loutfi M., et al. “Impact of restenosis and disease progression on clinical outcome after multivessel stenting in diabetic patients”. Catheterization and Cardiovascular Interventions 58 (2003): 451-454.
31. Stefanini G., et al. “Management of myocardial revascularisation failure: an expert consensus document of the EAPCI”. EuroIntervention 16 (2020): e875-e890.
32. Parasca CA., et al. “Incidence, Characteristics, Predictors, and Outcomes of Repeat Revascularization After Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting: The SYNTAX Trial at 5 Years”. JACC: Cardiovascular Interventions 9 (2016): 2493-507.
33. Giustino G., et al. “Mortality After Repeat Revascularization Following PCI or Coronary Artery Bypass Grafting for Left Main Disease: The EXCEL trial”. JACC: Cardiovascular Interventions 13 (2020): 375-387.
34. Palmerini T., et al. “Mortality Following Nonemergent, Uncomplicated Target Lesion Revascularization After Percutaneous Coronary Intervention: An Individual Patient Data Pooled Analysis of 21 Randomized Trials and 32,524 Patients”. JACC: Cardiovascular Interventions 11 (2018): 892-902.
35. Escaned J. “Secondary coronary revascularisation: an emerging issue”. EuroIntervention 5 (2009): D6-13.
36. Taniwaki M., et al. “4-year clinical outcomes and predictors of repeat revascularization in patients treated with new-generation drug-eluting stents: a report from the RESOLUTE All-Comers trial (A Randomized Comparison of a Zotarolimus-Eluting Stent With an Everolimus-Eluting Stent for Percutaneous Coronary Intervention)”. Journal of the American College of Cardiology 63 (2014): 1617-1625.
37. Stone GW., et al. “A prospective natural-history study of coronary atherosclerosis”. The New England Journal of Medicine 364 (2011): 226-235.
38. Taniwaki M., et al. “The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study”. European Heart Journal 36 (2015): 2167-2176.
39. Valgimigli M., et al. “2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)”. European Heart Journal3 (2018): 213-260.
40. Knuuti J., et al. “2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes”. European Heart Journal3 (2020): 407-477.
41. Sharma A., et al. “Duration of Dual Antiplatelet Therapy Following Drug-Eluting Stent Implantation in Diabetic and Non-Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials”. Progress in Cardiovascular Diseases4-5 (2018): 500-507.
42. Gurbel PA., et al. “Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study”. Circulation 121 (2010): 1188-1199.
43. James S., et al. “Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial”. European Heart Journal 31 (2010): 3006-3016.
44. Study Investigators NICE-SUGAR., et al. “Intensive versus conventional glucose control in critically ill patients”. The New England Journal of Medicine 360 (2009): 1283-1297.
45. Ahmed S., et al. “Acute coronary syndromes and diabetes: Is intensive lipid lowering beneficial? Results of the PROVE ITTIMI 22 trial”. European Heart Journal 27 (2006): 2323-2329.

Citation

Citation: Dogot Marta., et al. “Risk Factors Associated with Repeat Revascularization within 7 Years of First Percutaneous Coronary Intervention in a Diabetic Patient”.Acta Scientific Medical Sciences 6.7 (2022): 93-100.

Copyright

Copyright: © 2022 Dogot Marta., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.