Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery

Peculiarities of the disease discharge and long-term results of treatment in patients with acute coronary syndrome and diabetes mellitus

Authors: M.A. Alekseeva, E.U. Asymbekova, N.K. Akhmedyarova, O.M. Sherstyannikova, E.F. Tugeeva, Yu.I. Buziashvili

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2019-16-4-281-292

UDC: 616.132.2-008.6:616.379-008.64]-089.168

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (4): 281-292

Quote as: Alekseeva M.A., Asymbekova E.U., Akhmedyarova N.K., Sherstyannikova O.M., Tugeeva E.F., Buziashvili Yu.I. Peculiarities of the disease discharge and long-term results of treatment in patients with acute coronary syndrome and diabetes mellitus. Сlinical Physiology of Circulation. 2019; 16 (4): 281–92 (in Russ.). DOI: 10.24022/1814-6910-2019-16-4281-292

Received / Accepted:  18.07.2019/28.08.2019

Full text:  

Abstract

Objective: to study the clinical features of the course of the disease in patients with acute coronary syndrome (ACS) in combination with diabetes and long-term results of treatment.
Material and methods. On a voluntary basis, we examined 278 patients with ACS who were admitted to the clinical diagnostic department of the Bakoulev Center, which were subsequently divided into two groups according to the presence or absence of a comorbid state – diabetes. Group 1 consisted of 62 patients with ACS and diabetes, group 2 included 216 patients with ACS.
Results. Patients with ACS and diabetes are distinguished by a higher median age – 59 (40–84) years (p<0.025). They have high rates of body mass index – 30.6 (18.8–40.7) kg/m2, the proportion of patients with obesity was 72.6% (p=0.002). For patients with ACS and diabetes, a common and severe course of atherosclerosis is characteristic: peripheral artery atherosclerosis was found in diabetes by 14.4% more than in the absence of diabetes (p=0.03), diffuse coronary atherosclerosis was prevalent in them (p=0.006), the multiplicity of lesions of the coronary bed (p=0.003). ACS with and without elevation ST were the same in both groups. In both situations, the primary episode of ACS prevailed over the second. In patients with diabetes mellitus, ACS against the background of a previos myocardial infarction was significantly greater than in patients without diabetes mellitus. Percutaneous coronary intervention (PCI) was performed in the 1st group of patients in 66% of cases, in the 2nd group in 71% of cases. Urgent coronary bypass surgery in 1.6% and 3.7% of cases, respectively, delayed coronary bypass surgery – 11.3% and 11.1%. In the acute period of ACS, patients with diabetes have high rates of hospital mortality (8.1% of cases) (p=0.0003). Diabetes mellitus is a significant predictor of hospital mortality in patients with ACS (χ2=9.8, p=0.02). According to the results of re-coronary angiography, the progression of atherosclerosis occurred in 26% of patients with diabetes and 12% in patients without diabetes (p=0.008). Diabetes mellitus affects the progression of atherosclerosis in patients with ACS and myocardial revascularization (χ2=3.6, p=0.05).
Conclusion. When combined with ACS and diabetes, patients were older, with a predominance of the proportion of obese people, severe and widespread atherosclerosis of the coronary and peripheral arteries, with indications of a history of myocardial infarction. With diabetes, there were more women than those without diabetes. Diabetes mellitus is accompanied by high hospital and non-hospital mortality of patients. In the long term – the prognosis for life in such patients is unfavorable, expressed in refractoriness to treatment with statins, progression of atherosclerosis.

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About Authors

  • Mariya A. Alekseeva, Postgraduate; orcid.org/0000-0002-3736-2991
  • El’mira U. Asymbekova, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-5422-2069
  • Nazli K. Akhmedyarova, Cand. Med. Sc., Researcher; orcid.org/0000-0001-7157-6312
  • Ol’ga M. Sherstyannikova, Cand. Med. Sc., Researcher; orcid.org/0000-0002-0340-695Х
  • El’vina F. Tugeeva, Dr. Med. Sc., Senior Researcher Yuriy I. Buziashvili, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Head of Clinical-Diagnostic Department; orcid.org/0000-0001-7016-7541


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