Predictors and clinical outcomes of slow flow phenomenon in diabetic patients with chronic coronary syndrome.
Humans
Male
Female
Middle Aged
Retrospective Studies
Coronary Circulation
Aged
Risk Factors
Coronary Angiography
Time Factors
Risk Assessment
Chronic Disease
Angina, Stable
/ physiopathology
Diabetes Mellitus
/ epidemiology
Prognosis
No-Reflow Phenomenon
/ physiopathology
Blood Glucose
/ metabolism
Predictive Value of Tests
Chronic coronary syndrome
Clinical outcomes
Diabetic patients
Slow flow phenomenon
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
27 Sep 2024
27 Sep 2024
Historique:
received:
14
02
2024
accepted:
04
09
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
Coronary slow flow (CSF) is characterized by late distal coronary perfusion of coronary arteries at the time of angiography despite the vessels appearing normal. The importance of CSF is still debatable. Therefore, this study aimed to investigate CSF's predictors and clinical outcomes in diabetic patients with chronic coronary syndrome (CCS). This retrospective study included 250 diabetic patients diagnosed with chronic stable angina and referred for coronary angiography (CAG), showing normal coronaries with CSF (Group I) and 240 diabetic patients with normal coronaries and normal flow (Group II). The patients in both groups were followed up for one year to evaluate clinical outcomes. The incidence of major adverse cardiac events (MACE) was higher in Group I than in Group II, but the difference was not statistically significant except when the composite endpoints of STEMI, NSTEMI, and unstable angina were combined under the term ACS. The independent predictors of CSF, as detected by multivariate regression analysis, were body mass index (BMI) (OR = 0.694, 95% CI = 0.295-0.842, P = 0.010), blood glucose during catheterization (OR = 0.647, 95% CI = 0.298-0.874, P = 0.008), serum triglycerides (OR = 0.574, 95% CI = 0.289-0.746, P = 0.010), and the neutrophil/lymphocyte ratio (NLR) (OR = 0.618, 95% CI = 0.479-0.892, P = 0.001). Serum triglyceride levels, BMI, NLR, and high blood glucose levels at the time of catheterization were independent predictors of CSF in diabetic patients. MACE levels were higher in diabetic patients with CSF.
Sections du résumé
BACKGROUND
BACKGROUND
Coronary slow flow (CSF) is characterized by late distal coronary perfusion of coronary arteries at the time of angiography despite the vessels appearing normal. The importance of CSF is still debatable. Therefore, this study aimed to investigate CSF's predictors and clinical outcomes in diabetic patients with chronic coronary syndrome (CCS).
PATIENT AND METHODS
METHODS
This retrospective study included 250 diabetic patients diagnosed with chronic stable angina and referred for coronary angiography (CAG), showing normal coronaries with CSF (Group I) and 240 diabetic patients with normal coronaries and normal flow (Group II). The patients in both groups were followed up for one year to evaluate clinical outcomes.
RESULTS
RESULTS
The incidence of major adverse cardiac events (MACE) was higher in Group I than in Group II, but the difference was not statistically significant except when the composite endpoints of STEMI, NSTEMI, and unstable angina were combined under the term ACS. The independent predictors of CSF, as detected by multivariate regression analysis, were body mass index (BMI) (OR = 0.694, 95% CI = 0.295-0.842, P = 0.010), blood glucose during catheterization (OR = 0.647, 95% CI = 0.298-0.874, P = 0.008), serum triglycerides (OR = 0.574, 95% CI = 0.289-0.746, P = 0.010), and the neutrophil/lymphocyte ratio (NLR) (OR = 0.618, 95% CI = 0.479-0.892, P = 0.001).
CONCLUSION
CONCLUSIONS
Serum triglyceride levels, BMI, NLR, and high blood glucose levels at the time of catheterization were independent predictors of CSF in diabetic patients. MACE levels were higher in diabetic patients with CSF.
Identifiants
pubmed: 39333842
doi: 10.1186/s12872-024-04164-8
pii: 10.1186/s12872-024-04164-8
doi:
Substances chimiques
Blood Glucose
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
518Informations de copyright
© 2024. The Author(s).
Références
Wang M, Li Y, Li S, Lv J. Endothelial dysfunction and diabetic cardiomyopathy. Front Endocrinol. 2022;13:851941.
doi: 10.3389/fendo.2022.851941
Rouzbahani M, Farajolahi S, Montazeri N, Janjani P, Salehi N, Rai A, et al. Prevalence and predictors of slow coronary flow phenomenon in Kermanshah province. J Cardiovasc Thorac Res. 2021;13(1):37.
doi: 10.34172/jcvtr.2021.03
pubmed: 33815700
pmcid: 8007890
Seyyed Mohammadzad MH, Khademvatani K, Gardeshkhah S, Sedokani A. Echocardiographic and laboratory findings in coronary slow flow phenomenon: cross-sectional study and review. BMC Cardiovasc Disord. 2021;21(1):1–8.
doi: 10.1186/s12872-021-02044-z
Ooi EL. lschaemia With No Obstructive Coronary Artery Disease (INOCA): Insights Into Assessment and Obstructive Sleep Apnoea Association. 2022.
Gomaa A, Radwan HI, Gad MM. Predictors of coronary slow flow in stable coronary artery disease. J Indian Coll Cardiol. 2017;7(3):109–15.
doi: 10.1016/j.jicc.2017.05.001
Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR, et al. Guidelines for performance, interpretation, and application of stress echocardiography in ischemic heart disease: from the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33(1):1–41.
doi: 10.1016/j.echo.2019.07.001
pubmed: 31740370
Abd-Elghaffar SA-E, El Sheikh RG, Gaafar AA, Elbarbary YH. Assessment of risk factors, clinical presentation and angiographic profile of coronary slow flow phenomenon. J Indian Coll Cardiol. 2022;12(1):19–24.
doi: 10.4103/jicc.jicc_6_21
Bergman S. Optimizing percutaneous coronary intervention. Lund University, Faculty of Medicine; 2022.
Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow Flow–Prevalence and Clinical Correlations–. Circ J. 2012;76(4):936–42.
doi: 10.1253/circj.CJ-11-0959
pubmed: 22293446
Mukhopadhyay S, Kumar M, Yusuf J, Gupta VK, Tyagi S. Risk factors and angiographic profile of coronary slow flow (CSF) phenomenon in north Indian population: an observational study. Indian Heart J. 2018;70(3):405–9.
doi: 10.1016/j.ihj.2017.09.001
pubmed: 29961458
Al Suwaidi J, Higano ST, Holmes DR, Lennon R, Lerman A. Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries. J Am Coll Cardiol. 2001;37(6):1523–8.
doi: 10.1016/S0735-1097(01)01212-8
pubmed: 11345360
Ghaffari S, Tajlil A, Aslanabadi N, Separham A, Sohrabi B, Saeidi G, et al. Clinical and laboratory predictors of coronary slow flow in coronary angiography. Perfusion. 2017;32(1):13–9.
doi: 10.1177/0267659116659918
pubmed: 27412375
Zhao Z-W, Ren Y-G, Liu J. Low serum adropin levels are associated with coronary slow flow phenomenon. Acta Cardiol Sinica. 2018;34(4):307.
Aciksari G, Cetinkal G, Kocak M, Atici A, Celik FB, Caliskan M. The relationship between triglyceride/high-density lipoprotein cholesterol ratio and coronary slow-flow phenomenon. Int J Cardiovasc Imaging. 2022;38(1):5–13.
doi: 10.1007/s10554-021-02387-w
pubmed: 34453654
Dai Y-X, Li C-G, Huang Z-Y, Zhong X, Qian J-Y, Liu X-B, et al. Clinical and angiographic characteristics of patients with slow coronary flow. Zhonghua Xin xue guan bing za zhi. 2011;39(7):642–6.
pubmed: 22088246
Pavithran N, Kumar H, Menon AS, Pillai GK, Sundaram KR, Ojo O. South Indian cuisine with low glycemic index ingredients reduces cardiovascular risk factors in subjects with type 2 diabetes. Int J Environ Res Public Health. 2020;17(17):6232.
doi: 10.3390/ijerph17176232
pubmed: 32867226
pmcid: 7504299
Xia S, Deng S-B, Wang Y, Xiao J, Du J-L, Zhang Y, et al. Clinical analysis of the risk factors of slow coronary flow. Heart Vessels. 2011;26:480–6.
doi: 10.1007/s00380-010-0081-5
pubmed: 21207039
Dharma S, Mahavira A, Haryono N, Sukmawan R, Dakota I, Siswanto BB, et al. Association of hyperglycemia and final TIMI flow with one-year mortality of patients with acute ST-segment elevation myocardial infarction undergoing primary PCI. Int J Angiol. 2019;28(03):182–7.
doi: 10.1055/s-0039-1691811
pubmed: 31452586
pmcid: 6707796
Salvatore T, Galiero R, Caturano A, Vetrano E, Loffredo G, Rinaldi L, et al. Coronary microvascular dysfunction in diabetes mellitus: pathogenetic mechanisms and potential therapeutic options. Biomedicines. 2022;10(9):2274.
doi: 10.3390/biomedicines10092274
pubmed: 36140374
pmcid: 9496134
Madak N, Nazlı Y, Mergen H, Aysel S, Kandaz M, Yanık E, et al. Acute phase reactants in patients with coronary slow flow phenomenon. Anadolu Kardiyol Derg. 2010;10(5):416–20.
doi: 10.5152/akd.2010.139
pubmed: 20929698
Zhang E, Gao M, Gao J, Xiao J, Li X, Zhao H, et al. Inflammatory and hematological indices as simple, practical severity predictors of microdysfunction following coronary intervention: a systematic review and meta-analysis. Angiology. 2020;71(4):349–59.
doi: 10.1177/0003319719896472
pubmed: 32013536
Sanghvi S, Mathur R, Baroopal A, Kumar A. Clinical, demographic, risk factor and angiographic profile of coronary slow flow phenomenon: a single centre experience. Indian Heart J. 2018;70:S290–4.
doi: 10.1016/j.ihj.2018.06.001
pubmed: 30595277
pmcid: 6310702
Cem Ö, KayapİNar O, AfŞİN H. Association between Plasma Levels of Fibrinogen and the Presence and Severity of Coronary Artery Ectasia. Sakarya Tıp Dergisi. 2020;10(1):82–92.
Yurdam FS, Kiş M. The relationship between TIMI flow and MAPH score in patients undergoing primary percutaneous coronary intervention for STEMI. Int Heart J. 2023;64(5):791–7.
doi: 10.1536/ihj.23-024
pubmed: 37704410
Yılmaz M, Korkmaz H, Bilen MN, Uku Ö, Kurtoğlu E. Could neutrophil/lymphocyte ratio be an indicator of coronary artery disease, coronary artery ectasia and coronary slow flow? J Int Med Res. 2016;44(6):1443–53.
doi: 10.1177/0300060516664637
pubmed: 28322100
pmcid: 5536743
Bajari R, Tak S. Predictive prognostic value of neutrophil–lymphocytes ratio in acute coronary syndrome. Indian Heart J. 2017;69:S46–50.
doi: 10.1016/j.ihj.2017.01.020
pubmed: 28400038
pmcid: 5388019
Amirzadegan A, Motamed A, Davarpasand T, Shahrzad M, Tokaldany M. Clinical characteristics and mid-term outcome of patients with slow coronary flow. Acta Cardiol. 2012;67(5):583–7.
doi: 10.1080/AC.67.5.2174134
pubmed: 23252010
Yu J, Yi D, Yang C, Zhou X, Wang X, Zhang Z et al. Major adverse Cardiovascular events and prognosis in patients with coronary slow Flow. Curr Probl Cardiol. 2023:102074.