Background . Problems surrounding comorbidities of type 2 diabetes mellitus and coronary heart disease are some of the most important in medical science and practice, given their mutually negative impact on patients’ prognoses and quality of life. Aims . To study the impact of type 2 diabetes on the long-term prognoses of patients of different age categories, status-post acute myocardial infarction. (Data obtained from the ‘Register of Acute Myocardial Infarction’.) Materials and methods . The main data source was the ‘Register of Acute Myocardial Infarction’, maintained in Tomsk for more than 30 years. The study included 862 patients with acute myocardial infarction. The patients were monitored for 5 years. The primary endpoint was death from any cause during the observation period. Results . We separated the study cohort into 2 groups depending on patients’ ages: Group 1 (n = 358) included patients older than working age, Group 2 (n = 504) consisted of younger, employable patients. The combination of ischaemic heart disease and type 2 diabetes mellitus were diagnosed in 208 patients. The combination of ischaemic heart disease and type 2 diabetes was the cause of adverse prognosis among elderly patients and led to increased mortality rate during the 5-year post-infarction period (p = 0.0003). However, among younger, working patients who suffered myocardial infarction, the presence of type 2 diabetes did not have an independent negative effect on long-term disease prognosis. While in employable patients, a long history of diabetes mellitus significantly aggravated the course of the post-infarction period (p = 0.004). Conclusions . These data suggest an ambiguous prognostic effect of type 2 diabetes mellitus among working age and elderly patients status post myocardial infarction, in agreement with experimental studies conducted on laboratory animals. Further comprehensive analyses of the clinical and experimental data are needed to optimise therapies for patients who suffer from type 2 diabetes and comorbid ischaemic heart disease.

/pdf/diabetes-mellitus-type-2-and-acute-myocardial-infarction-znjldeo9fj.pdf

Diabetes mellitus type 2 and acute myocardial infarction: prognostic options for interaction in patients of different age groups

Character of coronary vasculature lesions in patients with non-Q myocardial infarction in gender and age aspects

Aim. Assessment of the dynamics of the structural and functional state of the myocardium in patients with non Q-wave myocardial infarction in 3 and 6 months depending on the use of the blocker of the mineralocorticoid receptors eplerenone.
Material and Methods. We examined 77 patients (63.6% males) with non Q-wave myocardial infarction aged from 50 to 79 (mean 64.1±1.0) years. Hospital management strategy was elaborated in accordance with modern standards for the treatment of acute coronary syndrome without ST-elevation, which envisaged stratification of risk on the GRACE scale (estimated risk of mortality in the near future) and the choice of adequate procedure of the invasive strategy. The structural and functional state of the myocardium was evaluated using echocardiography, which was performed in the M-, B- and D-modes.
Results and Discussion. A substantial increase in the total score of echocardiographic dynamics at the 6th month was demonstrated, as compared to the 3rd month of treatment, indicating a certain association of positive hemodynamic changes with the duration of basic treatment. An analysis of the total score of echocardiographic dynamics during the 3rd and 6th months of treatment indicated a significant increase in the indicator for all periods of observation in the eplerenone group, which showed a more convincing anti-remodeling effect in the group of patients with non-Q myocardial infarction who were administered the drug.
Conclusions. The use of eplerenone in addition to basic treatment is associated with more convincing anti-remodeling and hemodynamic effects during the 3rd and 6th months of treatment. Positive hemodynamic effects of the drug exhibit a certain dependence on the duration of treatment, which is characterized by more powerful dynamics of most echocardiographic parameters on the 6th compared to the 3rd month of observation.

/pdf/the-influence-of-the-blocker-of-mineralocorticoid-receptors-3g9nl15bhk.pdf

The influence of the blocker of mineralocorticoid receptors eplerenone on the dynamics of the structural-functional state of the myocardium in patients with non Q-wave myocardial infarction after 3 and 6 months of treatment

Dynamics of the myocardial structural and functional state in patients with non Q-wave myocardial infarction during 3 and 6 months follow-up in connection with percutaneous angioplasty

Aim. To evaluate short- and long-term prognosis of myocardial infarction (MI) depending on occurrence of pathologic Q-wave on ECG and time of its appearance. Material and methods. 616 patients with initial ST-elevated MI were included into the study — 254 women and 362 men, aged 62.1±11.2. All patients were split up three groups depending on occurrence of pathologic Q-wave on ECG and time of its appearance. First group consisted of 311 patients with early Q-wave (during first 6 hours from onset of MI symptoms). Second group consisted of 120 patients with late Q-wave (from 6 to 24 hours from onset of MI symptoms). Third group consisted of 185 patients with non-Q-wave MI. Results. The hospital lethality in the patients with early Q-wave was significantly higher than this in patients of the second and the third groups. However, we didn’t reveal significant differences between patients with late Q-wave and patients without Q-wave on ECG. The incidences of cardiac death (sudden death and fatal MI), non-fatal MI and hospitalization because of unstable angina was assessed during next two years. During the follow-up period patients of three groups had similar incidences of the non-fatal MI and hospitalization because of unstable angina. However, incidence of cardiac death was significantly higher in early Q-wave group in comparison with non-Q-wave group. Conclusion. Occurrence of pathologic Q-wave on ECG and time of its appearance should be taken into account to assessed short- and long-term prognosis of MI.

/pdf/prognostic-value-of-pathologic-q-wave-and-time-of-its-27tt4g3rxw.pdf

V. N. Simulin

Papers

Prognostic value of pathologic q-wave and time of its appearance in patients with myocardial infarction: comparison study