Clinical and Functional Features of Acute Coronary Syndrome in Patients with Concomitant Type 2 Diabetes Mellitus

Abstract

Introduction. According to various international registries, the proportion of patients with type 2 diabetes mellitus in a cohort of patients with acute coronary syndrome ranges from 22.0 to 34.0 %. The onset of acute coronary syndrome in those patients occurs, on average, 14.6 years sooner than in patients without diabetes. Diabetes mellitus in patients within first 30 days after myocardial infarction and within next 1–5 years is associated with a higher hospital and general mortality. Aim. To find out the clinical and functional peculiarities of the acute coronary syndrome and concomitant type 2 diabetes mellitus. Materials and methods. 102 patients (49 men and 53 women, aged 54 – 75 years) were examined. Depending on the clinical variant of acute coronary syndrome and the presence or absence of concomitant diabetes, patients were stratified into the following groups: the first group included 60 patients with unstable angina and with non-ST myocardial infarction, including 33 patients with diabetes and 27 patients without diabetes; the second group included 42 patients with ST myocardial infarction, which included 24 patients with diabetes and 18 patients with- out diabetes. Results and discussion. In patients with acute coronary syndrome and concomitant type 2 diabetes mellitus was recorded a late hospitalization in specialized departments, increased heart rate and a greater number of episodes of sinus tachycardia, higher levels of systolic and diastolic blood pressure, the greater size of the left atrium, increasing blood glucose levels and also atherogenic dyslipidemia. For patients with unstable angina and non-ST myocardial infarction the presence of concomitant type 2 diabetes, characterized by lower indices of left ventricular ejection fraction and slightly higher prevalence of symptoms of acute heart failure were observed. In patients with ST myocardial infarction and diabetes increased interventricular septum thickness, posterior wall of the left ventricle, prolongation of QT interval and a slightly higher tendency of patients to ventricular tachycardia and ventricular fibrillation compared with patients without diabetes were observed. Conclusions. Patients with the acute coronary syndrome and concomitant type 2 diabetes were characterized by late hospitalization in specialized departments, apparently due to the presence of atypical and silent disease that requires diagnostic coronarography for further diagnosis. The flow of acute coronary syndrome in these patients was characterized by a higher heart rate, higher blood pressure, prolongation of QT interval, frequent arrhythmias and signs of acute heart failure and subsequently with poorer prognosis.

Keywords

• acute coronary syndrome
• diabetes mellitus