To access this material please log in or register

Register Authorize

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.
  1. Аметов А. С., Соловьева О. Л. Сердечно-сосудистые осложнения при сахарном диабете: патогенез и пути коррекции. РМЖ эндокринология. 2011;27:1694–1699.
  2. Maier B, Thimme W, Kallischnigg G et al. Does diabetes mellitus explain the higher hospital mortality of women with acute myocardial infarction? Results from the Berlin Myocardial Infarction Registry. J Investig Med. 2006 Apr;54 (3):143–51.
  3. Glowania I, Czech A. The destiny of persons with diabetes mellitus type 2 after first myocardial infarction – analysis of the cohort living in well defined environment. Pol Arch Med Wewn. 2006 Jan;115 (1):29–36.
  4. Grant PJ. Diabetes mellitus as a prothrombotic condition. J Intern Med. 2007 Aug;262 (2):157–72.
  5. Hong YJ, Jeong MH, Choi YH et al. Plaque characteristics in culprit lesions and inflammatory status in diabetic acute coronary syndrome patients. J Am Coll Cardiol. Cardiovascular Imaging. 2009 Mar;2 (3):339–49.
  6. Undas A, Wiek I, Stêpien E et al. Hyperglycemia is associated with enhanced thrombin formation, platelet activation, and fibrin clot resistance to lysis in patients with acute coronary syndrome. Diabetes Care. 2008 Aug;31 (8):1590–5.
  7. Pitsavos C, Kourlaba G, Panagiotakos DB, Stefanadis C. Charac­teristics and in-hospital mortality of diabetics and nondiabetics with an acute coronary syndrome; the GREECS study. Clin Cardiol. 2007 May;30 (5):239–44.
  8. Дедов И. И., Шестакова М. В. Алгоритмы специализирован­ной ме­ди­цинской помощи больным сахарным диабетом. – М.:2011. –115с.
  9. Jánosi A, Ofner P, Jánossy J et al. Myocardial infarct and diabetes mellitus: incidence, management and prognosis. Orv Hetil. 2007 May 18;138 (20):1243–7.
  10. Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006 Jul 1;368 (9529):29–36.
  11. Egstrup M, Henriksen FL, Høfsten DE et al. Prevalence and prognostic significance of pathological glucose metabolism in acute myocardial infarction. Ugesk Laeger. 2008 Mar 10;170 (11):940–2.
  12. Hirakawa Y, Masuda Y, Kuzuya M et al. Influence of diabetes mellitus on in-hospital mortality in patients with acute myocardial infarction in Japan: a report from TAMIS-II. Diabetes Res Clin Pract. 2007 Jan;75 (1):59–64.
  13. Sejil S, Janand-Delenne B, Avierinos JF et al. Six-year follow-up of a cohort of 203 patients with diabetes after screening for silent myocardial ischaemia. Diabet Med. 2006 Nov;23 (11):1186–91.
  14. Александров А. А, Дедов И. И. Сердечно-сосудистая патология и сахарный диабет: статины и «микрососудистая ишемия» миокарда.Consilium Medicum.2004;6 (9).
  15. Toyoda K, Nakano A, Fujibayashi Y et al. Diabetes mellitus impairs myocardial oxygen metabolism even in non-infarct-related areas in patients with acute myocardial infarction. Int J Cardiol. 2007 Feb 14;115 (3):297–304.
  16. Goldberg RJ, Kramer DG, Lessard D et al. Serum glucose levels and hospital outcomes in patients with acute myocardial infarction without prior diabetes: a community-wide perspective. Coron Artery Dis. 2007 Mar;18 (2):125–31.
  17. Li L, Guo YH, Gao W, Guo LJ. The prognostic value of admission blood glucose level in acute myocardial infarction after primary percutaneous coronary intervention. Zhonghua Nei Ke Za Zhi. 2007 Jan;46 (1):25–8.
  18. Сахарный диабет: острые и хронические осложнения. Под ред. Дедова И. И., Шестаковой М. В. – M.: «МИА», 2011. – с. 259–290.
  19. Сыркин А. Л., Новикова Н. А., Терехин С. А. Острый коронарный синдром. – М.: «МИА», 2010. – с. 56–68.
  20. Шахнович Р. М. Острый коронарный синдром с подъемом сегмента ST. – М.: «ГЭОТАР-Медиа», 2010. – с. 44–46.
  21. Мазур Н. А. Практическая кардиология. – М.: «МЕДПРАК­ТИКА–М», 2009. – 616 с.
  22. Stephen SA, Darney BG, Rosenfeld AG. Synptoms of acute coronary syndrome in women with diabetes: an integrative review of the literature. Heart Lung. 2008 May-Jun;37 (3):179–89.
  23. Mayer DD, Rosenfeld A. Symptom interpretation in women with diabetes and myocardial infarction: a qualitative study. Diabetes Educ. 2006 Nov-Dec;32 (6):918–24.
  24. Федорова Е. Л., Бондарева З. Г., Куимов А. Д., Нестеренко Е. В. Факторы риска и особенности течения инфаркта миокарда у женщин. Клиническая медицина. 2003;6:28–32.
  25. Соколов Е. И. Диабетическое сердце. – М.: Медицина, 2002. – 416 с.
  26. Mather AN, Crean A, Abidin N et al. Relationship of dysglycemia to acute myocardial infarct size and cardiovascular outcome as determined by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010 Nov;12 (1):61.
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

To access this material please log in or register

Register Authorize
Ru En