Abstract 15036: Expression of Ischemic Preconditioning in Patients With Stable Multivessel Coronary Artery Disease With and Without Diabetes Mellitus
Background: Ischemic preconditioning (IP) is a powerful mechanism of myocardial protection and in humans it can be evaluated by sequential exercise tests (SET). Diabetes is associated with worse outcomes in patients with chronic coronary artery disease (CAD). Although experimental studies have shown that diabetes interferes negatively with the development of IP, it’s still unknown whether diabetes can influence the expression of IP in patients with stable multivessel CAD.
Objective: To evaluate and compare IP in chronic CAD patients with and without diabetes.
Methods: Diabetic and non-diabetic patients with chronic, stable CAD and preserved left ventricular systolic function were selected. The patients were submitted to two SETs with 30-minute interval between them. Ischemic parameters were compared between diabetic and non-diabetic patients. Ischemic preconditioning was considered present when time to 1mm ST-segment deviation was greater in the second of two SETs. Tests were analyzed by two independent and experienced cardiologists.
Results: From 2,620 consecutive CAD patients followed in a tertiary center, 361 with documented multivessel CAD, preserved systolic function and history of angina and/or recent positive treadmill test were selected. From those, 178 patients (63.8 ± 7.6 years) had IP evaluated by SETs: 91 were diabetic (group 1) and 87 were non-diabetic (group 2). The two groups were similar in terms of main prognostic parameters, besides previous infarction and cholesterol profile. In group 1, 62 (68.1%) patients developed IP and in group 2, 60 (68.9%) patients developed IP (P=0.90). When we compared the two groups, the improvement in time to 1mm ST-segment deviation was quite similar (79.0 vs 65.0 seconds, respectively for groups 1 and 2; P=0.07).
Conclusion: In this study, a substantial number of multivessel coronary artery disease patients developed ischemic preconditioning. However, diabetes mellitus seems not to influence the occurrence and magnitude of this important mechanism of myocardial protection.
- © 2013 by American Heart Association, Inc.