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Clinico-morphological features of acute myocardial infarction in patients with type 2 diabetes mellitus

Kakorin S.V.1, Karamyshev D.V.1, Mkrtumyan A.M.2, Nefedova G.A.3
1 – State Budgetary Health Care Institution “Municipal Hospital 4 of the Moscow Health Care Department”, Pavlovskaya 25, Moscow 115093
2 – State Budgetary Educational Institution “A. I. Evdokimov Moscow State University for Medicine and Dentistry” of the RF Ministry of Health Care, Delegatskaya 20, Bld. 1, Moscow 127473.
3 – N. V. Sklifosovsky Research Institute of Emergency Medicine, B. Sukharevskaya Pl. 3, Moscow 129090

Keywords: myocardial infarction, clinical presentation, pulmonary edema, myocardial rupture, type 2 diabetes mellitus

DOI: 10.18087/rhj.2014.6.1999

Background. In acute MI phase, death rate of patients with type 2 DM is 2–3 times higher than for patients without disorders of carbohydrate metabolism. Aim. To study in-hospital mortality; features of acute MI clinical presentation and time course; features of morphological changes in fatal MI in patients with type 2 DM; and to identify possible clinical predictors for MI complications and early death. Materials and methods. We have analyzed 527 case reports of patients with acute MI and 197 case reports and autopsy protocols of patients who died from acute MI. Results. In a hospital lacking equipment for interventional treatment, the incidence of in-hospital death rate from MI of patients with type 2 DM was 23.02 %. Disorders of carbohydrate metabolism were observed in 26.38 % of patients admitted to the cardiac intensive care unit. In 96 % of patients with type 2 DM who died from acute MI, the disease was complicated with pulmonary edema, which was significantly more frequent than in patients with normal carbohydrate metabolism. Incidence of myocardial scarring was significantly higher in patients with type 2 DM than in patients with normal carbohydrate metabolism (45.56±5.25 % vs. 35.51±4.63 %, respectively). Life-time overdiagnosis of MI took place in patients both with and without type 2 DM. Analysis of fatal outcome incidence within 6 hours of admission and after 6–12 hour stay in the hospital did not show any significant difference between numbers of patients in subgroups (t=1.33 / 0.28 / 0.72, respectively). The phase of myocardial ischemia was identified in 44.94±5.27 % of patients with acute MI and type 2 DM, which was significantly more frequent than in patients with normal carbohydrate metabolism (30.84±4.46 %, t=2.04; p<0.05). The incidence of MI necrotic phase was significantly higher in patients with normal carbohydrate metabolism (44.94±5.27 % with type 2 DM; 60.75±4.72 % without type 2 DM, t=2.23; p<0.05). The presence of atheromatous aortic lesions weakly negatively correlated with the number of atherosclerotic coronary arteries in patients without type 2 DM who died from MI. A similar weаk negative correlation of the presence of fibrous and calcined aortic plaques with the number of atherosclerotic coronary arteries was observed in patients with type 2 DM.
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Kakorin S. V., Karamyshev D. V., Mkrtumyan A. M. et al. Clinico-morphological features of acute myocardial infarction in patients with type 2 diabetes mellitus. Russian Heart Journal. 2014;13 (6):347–353

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