Characteristics of the acute myocardial infarction course in patients with type 2 diabetes mellitus before and after reperfusion therapy

Abstract

Introduction. Scientific research is currently being done to diagnose and manage comorbid conditions in patients. The importance of studying the pathophysiological mechanisms of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (DM) has been proven. The purpose of the study: to conduct a retrospective analysis before and after reperfusion therapy by evaluating the features of the AMI course in patients with type 2 DM. Material and methods. The study was conducted from January 10, 2020 to January 12, 2021. In total, 74 STEMI patients with or without type 2 DM, aged 59.42±7.66 years were examined at the Intensive Care Unit of the Government Institution “L. T. Malaya National Therapy Institute of the National Academy of Medical Sciences of Ukraine” and the Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” of Public Joint Stock Company “Ukrainian Railway”. Serum levels of insulin, adropin, irisin, fatty acid binding protein 4 (FABP4) and C1q/TNF-related protein (CTRP3) were detected by enzyme-linked immunosorbent assay. Analysis and processing of the findings obtained after examinations were carried out using the computer program IBM SPPS software, version 27.0 (IBM Inc., USA, 2020). Results and discussion. Before the treatment, patients with AMI and type 2 DM had significantly higher values of end-systolic size (ESS) by 5.56%, left atrium (LA) by 10.53%, left ventricular myocardial mass index (LVMMI) by 6.87% and lower values of systolic blood pressure (SBP) by 11.76%, atherogenic index (AI) by 5.80%, glucose by 25.71%, insulin by 39.92%, irisin by 15.34%, FABP4 by 19.76% compared to the values of these indicators 14 days after medicamentous therapy (p<0.05). Patients with AMI and type 2 DM had significantly higher values of adropin by 46.10%, irisin by 20.11%, CTRP3 by 28.78% and lower values of SBP by 17.65%, diastolic blood pressure by 12.38%, heart rate (HR) by 13.73%, pulse by 10.87%, body mass index by 5.57%, weight by 9.52%, glucose by 26.67%, insulin by 40, 75%, total cholesterol by 10.04%, very low-density lipoproteins by 24.75%, low-density lipoproteins by 8.52%, triglycerides by 27.06%, AI by 10.55%, FABP4 by 37.04% before treatment as compared to the values of these indicators 14 days after percutaneous coronary intervention (PCI) (p<0.05). Comparing the studied indicators between subgroups after medicamentous treatment and PCI, a significant decrease in HR by 8.33%, ESS by 4.11%, LA by 9.52%, LVMMI by 5.53%, FABP4 by 21.53% and an increase in the levels of adropin by 36.99%, irisin by 41.88%, CTRP3 by 30.25%, high-density lipoproteins (HDL) by 10.28% were identified (p<0.05). Conclusions. When compared PCI advantages due to the absence of a tendency to the left heart dilatation over the medicamentous therapy, improvements of energy and adipokine metabolism have been observed amid increased levels of adropin, irisin and CTRP3 and decreased levels of FABP4 in patients with AMI and type 2 DM. It should be noted that there has been a significant improvement in the state of energy and adipokine profiles under the conditions of performing PCI.