Nowadays treatment of patients with coronary artery disease (CAD) and concomitant type 2 diabetes mellitus (DM) needs further study. The aim. Evaluation of the clinical effect and glycemic variability of dapagliflozin in patients with angiographically confirmed CAD and concomitant type 2 DM. Materials and methods. The study involved 47 patients with angiographically confirmed CAD. The patients underwent laboratory blood tests, electrocardiography, echocardiography, continuous glucose monitoring and percutaneous coronary intervention (PCI). Depending on the usage of dapagliflozin 10 mg, the patients were divided into 2 groups: group I (+SGLT2i, n = 24) and group II (–SGLT2i, n = 23). The average follow-up period was 16 months. Results. Distribution of the examined patients by age, anthropometric characteristics, duration of DM, functional state of the heart and kidneys, smoking, the presence of acute cardiovascular events and previous PCI showed no statistically significant difference. In patients of group I, on the background of taking SGLT2i, a decrease in body mass index and improved glycemic profile were revealed. Patients in group II were more likely to have complaints of angina (4 [17.3%] vs 1 [4.3%], p>0.05); repeated coronary angiography in this group was significantly more likely to reveal progression to atherosclerotic CAD (4 [17.3%], p<0.05) which required re-revascularization. No fatalities were detected during the follow-up. Conclusion. Dapagliflozin has improved glycemic and lipid profile of the blood and long-term prognosis after PCI. Adding this drug to the treatment reduces the clinical progression of CAD, the need for re-hospitalization and cardiac revascularization.

Background. Despite modern methods for the diagnosis and treatment of impaired glucose metabolism, diabetes mellitus remains an independent risk factor and doubles the number of cardiovascular events (coronary heart disease, ischemic stroke, death). The effectiveness of modern methods for myocardial revascularization in patients with diabetes mellitus needs further researches. The purpose of this study is to evaluate risk factors and long-term outcomes of coronary artery revascularization in patients with coronary heart disease and concomitant prediabetes or overt diabetes mellitus. Materials and methods. This retrospective study involved 120 individuals with coronary heart disease who underwent revascularization of coronary arteries. Patients were divided into two groups according to the glycemic status: group I (main group) — prediabetes or diabetes mellitus (n = 58); group II (controls) — individuals without impaired glycemia (n = 62). Stenosis of coronary arteries was determined by coronary angiography. Treatment outcomes in both groups of patients were assessed as a progression of coronary artery atherosclerosis (repeated interventions caused by new atherosclerotic lesions or restenosis of preimplanted stent) and mortality rates. The average follow-up of patients in two groups is 3 years (minimum of 24 months). Results. Patients of group I predominantly had triple vessel disease (43.1 vs 16.1 %, p < 0.05); chronic occlusion of the heart vessels was diagnosed more often than in group II (43.1 vs 25.8 %, p < 0.05), which characterizes more severe course of disease. Compared to the control group, in patients of the main group, the incidence of myocardial infarction (45.9 vs 33.9 %, odds ratio (OR) 6.1 (95% confidence interval (CI) 2.76–13.6), p < 0.05), stroke (13.8 vs 3.2 %, OR 4.8 (95% CI 0.97–23.6), p < 0.05) and chronic renal failure (10.3 vs 1.6 %), OR 7.0 (95% CI 0.82–60.4), p < 0.05) was significantly higher. In contrast to individuals without diabetes mellitus, patients from group I had significantly lower systolic heart function (48.9 ± 11.9 % vs 54.61 ± 7.56 %, p < 0.05). Percutaneous coronary intervention was a method of choice for coronary artery revascularization in patients with coronary heart disease, but coronary artery bypass grafting was more commonly used in the presence of diabetes mellitus (24.1 vs 6.5 %, p < 0.05). The progression of coronary artery atherosclerosis prevailed in patients with impaired glucose metabolism (19.0 vs 6.5 %, OR 3.4 (95% CI 1.01–11.3), p < 0.05). Mortality in people from group I was higher (12.1 vs 1.6 %, OR 8.4 (95% CI 1.00–70.3), p < 0.05). Conclusions. Multivascular lesions of the coronary arteries caused a worse prognosis in patients with diabetes mellitus. The deve­lopment of recurrent circulatory disorders was more common in patients with impaired glucose metabolism. The presence of this pathology significantly increases the risk of myocardial infarction, stroke and chronic renal failure.

Coronary artery disease (CAD) is the leading cause for morbidity and mortality both in Ukraine and in the world, so the relevance of this problem for the society is undeniable. The priority is still to study the factors that affect both more severe CAD in patients with chronic coronary syndrome and after myocardial revascularization. The aim. To investigate the patterns of correlation between blood level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CAD severity, especially in patients with multivessel lesion, to confirm its status of a useful additional marker for assessing the condition of cardiovascular system and one of the instruments to affect the tactics of treatment. Materials and methods. The study is based on data obtained from a prospective analysis of 40 patients at the age of 51 to 82 years old from January to December 2019, whose complaints could indicate the CAD. All the patients underwent a comprehensive clinical and laboratory examination (complete blood count, biochemical blood test). The main instrumental examination method was coronary angiography; the patients were divided into 2 groups on the basis of the examination results. The quantitative degree of lesion was assessed using the SYNTAX Score for each patient. Results. The groups were comparable in terms of age, sex, and comorbidities. The groups differed significantly in terms of body mass index. Moreover, the groups differed in the level of the following biochemical markers: NT-proBNP (p=0.0001), cholesterol (p=0.02), low-density lipoproteins (p=0.009), creatinine (p=0.02), glomerular filtration rate (p=0.08). A significant correlation was found between the NT-proBNP level and the degree of CAD ρ=0.718 (p=0.0001). Conclusion. NT-proBNP significantly correlates with the SYNTAX Score and is the highest in the group of patients with multivessel coronary disease. This indicator requires further study as an additional marker for assessing the state of the cardiovascular system and can influence the choice of treatment.

We present a clinical case of continuous monitoring in a patient with coronary artery disease and concomitant type 2 diabetes mellitus. A 75-year-old patient with a history of coronary artery bypass graft surgery more than 10 years ago was admitted to the Ukrainian Children’s Cardiac Center, Clinic for Adults with complaints of angina pectoris. The patient had progressive atherosclerotic lesions of the coronary arteries despite of controlled risk factors (normal weight, regular monitoring of blood pressure, lipid profile, blood glucose and glycated hemoglobin [HbA1c], active lifestyle). The heart team decided to perform percutaneous coronary intervention which resulted in thrombolysis in myocardial infarction (TIMI) 3 flow. During continuous glycemic monitoring in the patient we detected nocturnal asymptomatic episodes of hypoglycemia. Together with endocrinologist we performed adjustment of drug treatment: the hypoglycemic drug sulfonylurea was changed to a sodium-glucose cotransporter 2 inhibitor. Three months later we repeated monitoring of glycemia and no episodes of hypoglycemia were detected, HbA1c was 6.4%. Conclusions. This case report shows that continuous glucose monitoring is an optimal method for diagnosing silent episodes of hypoglycemia and should be considered along with the control of the HbA1c level as an important auxiliary method for controlling type 2 diabetes mellitus in patients with cardiovascular diseases. Because glucose-lowering drugs such as sulfonylureas are risk factors for hypoglycemic episodes in patients with coronary artery disease, they should be changed to more effective and safer medications if possible.