Features of the course and complications of acute myocardial infarction in type 2 diabetes mellitus

Abstract

Aim. To study the effect of type 2 diabetes mellitus (DM) on the clinical and anamnestic and laboratory and instrumental characteristics of patients with acute myocardial infarction (MI).Material and methods. 102 patients with MI (41 women and 61 men) were examined. 2 groups were formed: the main group — patients with MI and DM2 (n=66) (group 1), the control group — patients with MI without DM (n=36) (group 2). A comparative analysis of laboratory data, concomitant diseases, complications of myocardial infarction in groups was performed. Statistical data processing was performed using the Excel package (Microsoft), Statistica 10 program (Statsoft Inc).Results. The mean age of the general group was 68 [43;96] years, patients with DM2 68,5 [43;88] years, patients without DM 67,5 [47;96] years. The average duration of MI in the general group was 13,5 [1;48] years, among patients with DM — 23 [1;48] years, without DM — 8 [1;34] years. DM in patients was statistically significantly correlated with a history of exertional angina (Kramer’s V coefficient 0,272, p=0,005). At the same time, there was no significant relationship between DM and previous revascularization interventions, such as a history of stenting (p=0,088), coronary artery bypass grafting (CABG) (p=0,291), as well as with stroke (p=0,09). Mean body mass index (BMI) values are found in lesions and without DM — 29,7 [19,5;46,9] kg/m2 and 27,3 [21,3;41,5] kg/m2, respectively. An analysis of the frequency of determining CKD (eGFR level <60 ml/min/1,73 m2) in groups revealed that in patients with type 2 DM, CKD of high severity was detected in 59% of cases, and in the group without DM this indicator was detected in 53%. Mean eGFR in the DM group was lower than in group 2: 54,5 [24;95] ml/min/1,73 m2 versus 58 [21;117] ml/min/1,73 m2, but the difference was not statistically detected (p>0,05). DM necessarily correlated with the presence of CHF in patients (Cramer’s V coefficient 0,243, p=0,02). In the DM group, low ejection fraction was detected significantly more often according to echocardiography: 58% (n=11) in group 1 versus 42% (n=8) in group 2 (p=0,011). A statistically significant relationship was found between the presence of DM in patients and pulmonary hypertension according to echocardiography (Cramer’s V coefficient 0,3, p=0.003). And in a comparative analysis of lipid profile indicators, there was no statistically significant difference in the groups.Conclusion. DM in post-MI patients was more often associated with reduced renal function and the presence of CHF, as well as a history of exertional angina. In addition, patients with DM were more likely to be obese, although in general, the average weight of patients with and without DM, as well as the average age, were comparable. The data obtained may indicate a significant negative impact of DM on the condition and prognosis of patients who have undergone MI, which underlines the feasibility of a multifactorial combined approach in the treatment of these patients.