THE EFFECT OF INTENSIVE GLYCEMIC CONTROL ON THE FACTORS DETERMINING PREDICTION COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH TYPE 2 DIABETES
https://doi.org/10.20538/1682-0363-2015-5-91-99
Abstract
Objective. To determine predictors of complications of myocardial infarction (MI) in patients with type 2 diabetes (2TDM) and it’s value of intensive glycemic control during insulin infusion.
Methods. The study included 112 patients with MI and 2TDM at first day of hospital admission with blood glucose level above 7.8 mmol/l. Prognosis of combined study endpoint included the death and ma-jor complications of MI for the hospital and long-term (6-month) stages. The statistical analysis was per-formed (Statistica 6.0 for Windows). The predictive value was assessed with ROC-curves analysis meth-od.
Results. Intensive glycemic control with insulin infusion reduced the activity of lipid peroxidation and improve prediction of study endpoint. Predictors of adverse hospital prognosis of MI in association with type 2 diabetes were hyperglycemia on admission above 10 mmol/l, and increase of C-peptide. The in-crease of C-peptide in the 1st and 7th day, hs-CRP on day 1, diene conjugates on the 7th day and glucose level on admission above 8.9 mmol/l (patients without 2TDM) and 14.3 mmol/l (patients with 2TDM) had the 6-month predictive value.
Conclusion. The strict achievement of the target level of glucose in acute MI improves it’s prognosis at the hospital and at a 6-month prospective study.
About the Authors
A. I. FedotovaRussian Federation
Fedotova Аlevtina I.
I. N. Vorozhtsova
Russian Federation
Vorozhtsova Irina N.
I. V. Маksimov
Russian Federation
Маksimov Ivan V.
T. Yu. Rebrova
Russian Federation
Rebrova Тatiana Yu.
S. A. Аfanasiev
Russian Federation
Аfanasiev Sergey А.
A. M. Gusakova
Russian Federation
Gusakova Аnna М.
T. E. Suslova
Russian Federation
Suslova Тatiana Ye.
V. A. Маrkov
Russian Federation
Маrkov Valentin А.
References
1. Sergeikina R.V., Lyashenko G.N., Shoenko N.P. et al. Osobennosti techeniya infarkta miokarda u bolnih, stradauschih saharnim diabetom [Features of the course of myocardial infarction in patients with diabetes mellitus]. Meditsina neot-lozhnykh sostoyaniy – The Medicine of Emergency, 2006, vol. 3, no. 4, pp. 52 (in Russian).
2. Arnold S.V., Lipska K.J., Li Y. et al. Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction. Am. Heart. J., 2014, vol. 168, no. 4, pp. 466–470. doi: 10.1016/j.ahj.2014.06.023.
3. Koichi T., Minako K., Tsutomu T. Newly diagnosed glucose intolerance and prognosis after acute myocardial infarction: comparison of postchallenge versus fasting glucose concentrations. Heart, 2012, vol. 98, pp. 848–854. doi:10.1136/heartjnl-2012-301629.
4. Hoebers L., Claessen B., Woudstra P. et al. Long-term mortality after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in patients with insulin-treated versus non-insulin-treated diabetes mellitus. EuroIntervention, 2014, vol. 10, no. 1, pp. 90–96. doi: 10.4244/EIJV10I1A15
5. Capes S.E., Hunt D., Malmberg K., Gerstein H.C. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet, 2000, vol. 355, no. 4, pp. 773–778.
6. Ansley D., Wang B. Oxidative stress and myocardial injury in the diabetic heart. J. Pathol., 2013, vol. 229, no. 2, pp. 232–241. doi: 10.1002/path.4113
7. Rodrigues B., Mendrot D., Figueroa T. et al. Short-term diabetes attenuates left ventricular dysfunction and mortality rates after myocardial infarction in rodents. Clinics (Sao Paulo), 2011, vol. 66, no. 8, pp. 1437–1442. doi: 10.1590/S1807-59322011000800022
8. Robbins M., Topol E.J. Inflammation in acute coronary syndromes. Acute coronary syndromes. E.J. Topol. 2nd ed. N.Y., Marcel Dekker Inc., 2001, pp. 1–31.
9. Duarte D.R., Minicucci M.F., Azevedo P.S. et al. The role of oxidative stress and lipid peroxidation in ventricular remod-eling induced by tobacco smoke exposure after myocardial infarction. Clinics (Sao Paulo), 2009, vol. 64, no. 7, pp. 691–697. doi: 10.1590/S1807-59322009000700014.
10. Wagner G.S., Freye C., Palmari S. et al. The evaluation of a QRS scoring system for estimating myocardial infarct size. Circulation, 1982, vol. 65, pp. 342–347.
11. Fedotova A.I., Katkov V.A., Maksimov I.V., Markov V.A. Opyt primeneniya protokola infusionnoy insulinoterapii v ostrom periode infarkta miokarda u pacientov s saharnim dia-betom [The experience of insulin infusion treatment diabetes mellitus patients with acute myocardial infarction]. Sibirskiy meditsinskiy zhurnal (Tomsk) – Siberian Medical Journal (Tomsk), 2011, vol. 26, no. 2, pp. 132–135 (in Russian).
12. Fedotova A.I., Maksimov I.V., Rebrova T.Yu., Afanasiev S.A., Markov V.A. Sostoyanie perekisnogo okisleniya lipidov i uroven svobodnih zhirnyh kislot u pacientov s sa-harnim diabetom 2 tipa pri provedenii intensivnogo glikem-icheskogo kontrolya v ostrom periode infarkta miocarda [The status of lipid peroxidation and the level of free fatty acids in patients with type 2 diabetes mellitus with insulin therapy and intensive glycemic control in the acute period of myocardial infarction]. Kardiovaskulyarnaya terapiya i pro-filaktika – Cardiovascular Therapy and Prevention, 2015, no. 2, pp. 25–30 (in Russian).
13. Krentz A.J. Type 2 diabetes and atherosclerotic cardio-vascular disease: do they share common antecedents? Circulation, 2003, vol. 108, pp. 1527–1532. doi: 10.1161/01.CIR.0000091257.27563.32
14. Suleiman M., Aronson D., Reisner S.A. et al. Admission C-reactive protein levels and 30-day mortality in patients with acute myocardial infarction. Am. J. Med., 2003, vol. 115, pp. 695–701.
15. Frangogiannis N.G. The immune system and the remodeling infarcted heart: cell biological insights and therapeutic оp-portunities. J. Cardiovasc. Pharmacol., 2014, vol. 63, no. 3, pp. 185–195. doi: 10.1097/FJC.0000000000000003.
16. Rodrigo R., Prieto J.C., Castillo R. Cardioprotection against ischaemia/reperfusion by vitamins C and E plus n-3 fatty acids: molecular mechanisms and potential clinical applica-tions. Clinical Science, 2013, vol. 124, pp. 1–15. doi: 10.1042/CS20110663
17. Runnman E.M., Lamp S.T., Weiss J.N. Enhanced utilization of exogenous glucose improves cardiac function in hypoxic rabbit ventricle without increasing total glycolytic flux. J. Clin. Invest., 1990, vol. 86, pp. 1222–1233.
18. Mitkovskaya N.P., Danilova L.I., Statkevich T.V. et al. Giperglikemia v ostrom periode infarkta miokarda [Hypergly-cemia in the acute period of myocardial infarction]. Medicin-skiy Zhurnal – Medical Journal, 2009, no. 4, pp. 67–70 (in Russian).
19. Karetnikova V.N. Markyori neblagopriyatnogo prognosa u bolnih ostrim infarktom miokarda s podjomom segmenta ST v sochetanii s narusheniyami uglevodnogo obmena. Avtoref. Dis. dokt. med. nauk [Markers of poor prognosis in patients with ST-segment elevation acute myocardial infarction in combination with disorders of carbohydrate metab-olism. Author. Diss. Dr. med. sci.]. Kemerovo, 2010. 47 p. (in Russian).
20. Yelenskaya T.S. Klinicheskoe i prognosticheskoe znachenie pokazateley insulinorezistentnosti u bolnyh infarktom miokarda s podjomom segmenta ST. Avtoref. Dis. kand. med. nauk [Clinical and prognostic value of measures of insulin resistance in patients with ST-segment elevation acute myocardial infarction. Author. Dis. cand. med. sci.]. Novosi-birsk, 2012. 21 p. (in Russian).
Review
For citations:
Fedotova A.I., Vorozhtsova I.N., Маksimov I.V., Rebrova T.Yu., Аfanasiev S.A., Gusakova A.M., Suslova T.E., Маrkov V.A. THE EFFECT OF INTENSIVE GLYCEMIC CONTROL ON THE FACTORS DETERMINING PREDICTION COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH TYPE 2 DIABETES. Bulletin of Siberian Medicine. 2015;14(5):91-99. (In Russ.) https://doi.org/10.20538/1682-0363-2015-5-91-99