ABSTRACT
PURPOSE: To assess the role of percutaneous coronary intervention (PCI) for in-hospital and one-year prognosis of ST elevation (STE) myocardial infarction (MI) patients with impaired glucose tolerance (IGT) or type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: This registry study included 601 STEMI patients admitted to hospital within 24 hours after STEMI onset during one year. According to medical history, dynamics of glycemia and results of oral glucose tolerance test patients were divided into 3 groups: (1) without disturbances of carbohydrate metabolism (DCM), (2) with IGT and (3) with T2DM. Primary PCI was performed in 373 (62.06%) patients while 228 (37.94%) received pharmacological treatment only. The following events were registered during one year after PCI: recurrent MI, stroke, admission for decompensated chronic heart failure (CHF), repeat emergency PCI. RESULTS: Patients with IGT and DM compared with those without DCM had similarly more severe course of the index MI and worse one-year prognosis. PCI significantly improved one-year prognosis in patients with and without DCM. CONCLUSION: Use of urgent PCI in STEMI patients with both DM and IGT is prognostically more beneficial in terms of lowering rate of adverse events during one year after MI.
Subject(s)
Diabetes Mellitus, Type 2/complications , Glucose Intolerance/complications , Myocardial Infarction , Percutaneous Coronary Intervention , Postoperative Complications , Carbohydrate Metabolism , Cardiovascular Agents/therapeutic use , Electrocardiography , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/epidemiology , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/statistics & numerical data , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Prognosis , Registries , Risk Factors , Russia/epidemiology , Severity of Illness Index , Treatment OutcomeABSTRACT
Multifocal atherosclerosis (MFA) and diabetes mellitus (DM) determine less favorable course of acute vascular catastrophes. We analyzed dependence of one year prognosis of patients with myocardial infarction (MI) with and without DM on the presence of multifocal atherosclerosis. The analysis showed that number of cardiovascular complications increased with increase of degree of severity of atherosclerosis. Negative impact of DM on prognosis was more pronounced in patients with MFA. This effect rose with rise of atherosclerosis severity. Moreover in patients with MI stenoses of extracranial arteries including those less than 50% appeared to be markers of the disease severity and unfavorable prognosis especially at the background of DM.
Subject(s)
Atherosclerosis/complications , Diabetes Mellitus, Type 2/complications , Electrocardiography , Myocardial Infarction/complications , Aged , Atherosclerosis/diagnosis , Atherosclerosis/epidemiology , Coronary Angiography , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/physiopathology , Prognosis , Risk Factors , Russia/epidemiology , Severity of Illness IndexABSTRACT
High mortality of patients with myocardial infarction (MI) determines pursuit of novel markers of risk as well as predictors of development of unfavorable outcome. The question of the role glycemia in development of cardiovascular complications in patients with acute coronary syndrome remains open. Analysis of in hospital mortality revealed U-shaped relacion ship between level of glycemia at admission and mortality in patients with ST elevation MI combined with diabetes mellitus (DM), and presence of direct linear relation - in patients without DM. Episodes of hypoglycemia registered in patients with MI and DM at hospital stage of treatment do not determine in hospital prognosis, but allow to distinguish a group of patients with unfavorable course of remote postinfarction period.
