Abstract
Purpose — to identify the possibility of improving the outcome of multimodality treatment of acute myocardial infarction (AMI) in type 2 diabetes mellitus (DM) patients by use of a succinate-containing drug.Materials and methods. The results of examination and treatment of 86 men aged 40 to 70 years with clinical diagnosis of AMI and concomitant type 2 DM were analyzed. The patients were split into two groups depending on use of the succinate-containing drug. Patients of the control group (38 men, 58.3±7.1 years old) received the standard treatment that included percutaneous coronary intervention (PCI). In the main group under study (48 men, 57.6±7.6 years old), the standard therapy complex was complemented with administration of a succinate-containing drug (1.5% succinic acid solution), which was administered first 30–60 minutes prior to PCI intravenously at a dose of 10–12 ml/kg; then, daily once a day, for 5 days at a dose of 5–6 ml/kg. Peculiarities of the AMI clinical course, dynamics of myocardial contractility, values of acid-base balance (ABB), glucose and lactate content, lipid peroxidation (LPO) and antioxidant system (AOS), rheological properties of the blood were evaluated.Results. During AMI type 2 DM patients developed compensated metabolic lactic acidosis and oxidative distress that manifested in considerable activation of LPO and insufficient activity of the enzymatic component of AOS, blood viscosity grew, elasticity of red blood cells fell. Decreased local and global myocardial contractility was noted as well. During PCI in this category of patients, cardiac rhythm disorders developed in 47.4% of cases, 23.7% of which were life threatening, such as multifocal ventricular extra systole and ventricular fibrillation. Conclusion. Administration of a succinate-containing drug during performance of PCI provided correction of the lipid peroxidation processes and rheological properties of the blood in the population studied, facilitated improvement of left ventricle’s systolic and diastolic function, reduced the risk of reperfusion complications.
Highlights
Acute myocardial infarction (AMI) is the most frequent cause of death among the type 2 diabetes mellitus (DM) patients
LVEF values were lower than normal values, wall motion score index (WMSI) of the left ventricle was increased in both groups and accompanied with a relatively low stroke volume (SV)
It has been proven that during AMI type 2 DM patients develop oxidative distress manifesting in considerable activation of lipid peroxidation (LPO) and insufficient activity of the enzymatic component of antioxidant system (AOS)
Summary
Acute myocardial infarction (AMI) is the most frequent cause of death among the type 2 diabetes mellitus (DM) patients. In DM patients, it occurs three times more often than in patients without DM and is characterized by a greater severity of the course. Due to various gactors, AMI associates with DM [1]. A number of authors have demonstrated that after AMI the main blood flow is restored by means of percutaneous coronary intervention (PCI) in the infarction-dependent arteries, adequate perfusion is not always achieved due to microvascular obstruction and development of reperfusion disorders [2, 3]. In patients with type 2 DM, predisposition to reperfusion disorders is profound and reaches 50% [4, 5]. There are experimental and clinical data evidencing that use of antioxidant drugs lessening the intensity of lipid peroxidation (LPO) processes and activating the antioxidant system (AOS) is capable of ensuring prophylaxis of reperfusion complications [6,7,8,9,10,11,12]
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