Abstract 3518: High Remnant Lipoprotein Levels Adversely Affect Short- and Long-term Outcomes for Patients with Acute Myocardial Infarction and Type 2 Diabetes Mellitus

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Takamitsu Nakamura ◽  
Mitsumasa Hirano ◽  
Yoshinobu Kitta ◽  
Yasushi Kodama ◽  
Akira Mende ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Long Term Outcomes ◽  
Remnant Lipoprotein ◽  
Type 2 Dm ◽  
Short And Long Term

Diabetes mellitus (DM) adversely affects prognosis in patients with acute myocardial infarction (AMI). Evidence shows that lipids-lowering therapy rather than glycemic control reduces macrovascular events in these patients, but it remains unclear which lipoprotein fractions contribute to negative effects. We previously showed that high levels of remnant lipoprotein, a triglyceride-rich lipoprotein, were an independent risk of future coronary events in patients with chronic coronary artery disease and DM. This study examined the hypothesis that remnant lipoproteinemia may adversely affect short- and long-term prognosis in patients with AMI and DM. Methods and Results: A prospective study was performed in 268 consecutive patients with Type 2 DM who were enrolled on day 5 after AMI. Fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) on day 5 after AMI were measured by an immunoseparation method. Adverse events, a composite of cardiac death, nonfatal MI, or recurrent unstable myocardial ischemia leading to unplanned revascularization therapy, were assessed during follow-up periods of 30 days and 1 year after AMI. Events rates were higher in patients with than without higher RLP-C levels (≥ 5.5 mg/dL, 50 th percentile of the distribution) during both short- and long-term follow-up periods (30 days post-MI, 8.2% [11/134 patients] vs. 2.2% [3/134 patients], p <0.05; 1 year post-MI, 15% [20] vs. 7.5% [10], p <0.05). In multivariate Cox hazard analyses, higher RLP-C levels were a significant predictor of adverse events during 30 days and 1 year independently of enrollment levels of glucose, LDL-C, and non-HDL-C (hazard ratios 2.1 and 1.7, 95% CI 1.8 – 3.9 and 1.3 – 4.0, respectively, both p<0.01). RLP-C levels were significantly correlated with C-reactive protein levels and intimal thickening of carotid artery at enrollment (r =0.30 and 0.39, respectively, both p<0.01). Conclusions: High remnant lipoprotein levels adversely affect short- and long-term outcomes in patients with AMI and Type 2 DM. The pro-inflammatory and pro-atherothrombogenic effects of remnant lipoprotein may contribute to coronary plaques instability in patients with AMI and Type 2 DM.

scholarly journals Asymmetric dimethylarginine – a marker of repeated cardiovascular events in patients with comorbid pathology

2021 ◽  
Vol 25 (4) ◽  
pp. 567-571
Author(s):  
D. A. Feldman
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Acute Myocardial Infarction ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Events ◽  
Asymmetric Dimethylarginine ◽  
Type 2 Dm

Annotation. Today, diseases of the cardiovascular system retain their leading position among the incidence in the world. The presence of comorbid pathology in the form of type 2 diabetes mellitus (DM) significantly complicates the course of these diseases, worsening its prognosis. The aim of the study: to analyze the prognostic value of asymmetric dimethylarginine (ADMA) as a marker of recurrent cardiovascular events in patients with acute myocardial infarction with type 2 diabetes for 6 months of follow-up. 120 patients were examined: group 1 – patients with acute myocardial infarction (AMI) in combination with type 2 diabetes mellitus (n=70), group 2 - patients with isolated AMI (n=50). The control group included 20 practically healthy individuals. All patients underwent general clinical and instrumental examinations, on the first day of AMI the level of ADMA was determined using a commercial test system "Human Asymmetrical Dimethylarginine ELISA". Statistical processing of the obtained data was performed using the software package StatSoft Inc, USA – "Statistica 6.0". The analysis of the average level of ADMA showed a significantly higher value of this indicator in patients with AMI in combination with type 2 DM than in patients without concomitant type 2 DM 2.57 times (1.57±0.11 μmol / l and 0.61±0.06 μmol / l, respectively), (p<0,05. ADMA level >1,72 μmol / l in patients with AMI in combination with type 2 DM and >0,69 μmol / l in patients with AMI without concomitant type 2 DM was identified as a predictor of recurrent acute myocardial infarction within 6 months of follow-up. Thus, the level of ADMA was higher in the presence of comorbid pathology in the form of type 2 DM in patients with AMI, reflecting endothelial dysfunction combining disease. It is advisable to further study this indicator of endothelial dysfunction as a predictor of the adverse course of AMI in combination with concomitant type 2 DM.

scholarly journals Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus

2007 ◽  
Vol 22 (12) ◽  
pp. 883-888 ◽  
Author(s):  
H. L. Koek ◽  
S. S. Soedamah-Muthu ◽  
J. W. P. F. Kardaun ◽  
E. Gevers ◽  
A. de Bruin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Short And Long Term ◽  
Long Term Mortality

Abstract 19771: Persistent Thrombocytopenia after Myocardial Infarction is Associated with Increased Short- and Long-Term Mortality

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Salim Virani ◽  
Scott Bassett ◽  
Mahboob Alam ◽  
Ravi Hira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Complications ◽  
Group Differences ◽  
Long Term Outcomes ◽  
Post Discharge ◽  
Short And Long Term ◽  
The Impact ◽  
Long Term Mortality

Background: Thrombocytopenia (TCP) occurs commonly in patients hospitalized with acute myocardial infarction (AMI). It is unclear whether persistent TCP after discharge among AMI survivors is associated with worse outcomes. Methods: We examined the impact of persistent post-discharge TCP on outcomes in a registry of consecutive AMI patients hospitalized between January 2004 and December 2007. In-hospital (IH) TCP was defined by a nadir platelet count < 150 x 109/L. Resolved TCP was defined as IH TCP which resolved within 3 months after discharge while persistent TCP was defined as IH TCP which did not resolve within 3 months. Results: Of 842 patients hospitalized for a first AMI, we examined data on 617 hospital survivors who had follow-up within 3 months of discharge and documented long-term outcomes. Of those, 474 (76.8%) patients did not experience IH TCP while 42 (6.8%) and 101 (16.4%) had persistent and resolved TCP, respectively (Table). Patients with persistent TCP were older, had worse comorbidities, and were more likely to have TCP at baseline and discharge. There were no inter-group differences in infarct size, major bleeding complications, revascularization, or ejection fraction at discharge. Mortality following discharge was higher at all time-points among AMI patients with persistent TCP compared to patients with resolved or without IH TCP (Figure). Patients with resolved TCP had comparable mortality to those without IH TCP. Conclusion: Persistent TCP within 3 months after hospital discharge for AMI is associated with significantly increased short- and long-term mortality compared to patients with recovered TCP or without IH TCP.

Poor adherence to guideline recommendations among patients with atrial fibrillation and acute myocardial infarction

2019 ◽  
Vol 26 (13) ◽  
pp. 1373-1382 ◽  
Author(s):  
Jarle Jortveit ◽  
Are H Pripp ◽  
Jørund Langørgen ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Anticoagulation Therapy ◽  
Long Term Outcomes ◽  
Recommended Treatment ◽  
Increased Risk ◽  
Norwegian Patient

Background The prevalence of atrial fibrillation in patients with acute myocardial infarction is largely unknown. The aims of the present study were to assess the prevalence of atrial fibrillation in a nationwide cohort of patients with acute myocardial infarction, to assess the prescription of anticoagulation therapy, and to study the long-term outcomes. Design A nationwide registry-based cohort study. Methods All patients registered in the Norwegian Myocardial Infarction Registry between 2013 and 2016 were included and followed up through 2017. Stroke rates during follow-up were obtained through linkage with the Norwegian Patient Registry. Results In total, 47,204 patients were registered in the Norwegian Myocardial Infarction Registry. Atrial fibrillation on admission was recorded in 5393 (11%) patients, and 2190 (5%) additional patients developed atrial fibrillation during their hospital stay. Only 45% of patients with atrial fibrillation on admission and CHA2DS2-VASc score ≥ 2 were treated with anticoagulation therapy prior to myocardial infarction, and 56% of patients with atrial fibrillation and CHA2DS2-VASc score ≥ 2 were prescribed anticoagulation therapy at discharge. Patients with myocardial infarction and atrial fibrillation had an increased risk of stroke or death during 822 (426, 1278) days of follow-up compared with patients without atrial fibrillation (multivariate adjusted hazard ratio 1.4, 95% confidence interval 1.3–1.4). Conclusions Almost half of patients with atrial fibrillation and myocardial infarction were not prescribed the guideline recommended treatment with anticoagulation therapy at discharge, and their long-term risk of stroke and death was increased compared with patients without atrial fibrillation. Increased efforts to improve the treatment of patients with myocardial infarction and atrial fibrillation are needed.

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

2018 ◽  
Vol 21 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Alla A. Garganeeva ◽  
Elena A. Kuzheleva ◽  
Ksenia N. Borel ◽  
Dina S. Kondratyeva ◽  
Sergey A. Afanasiev
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Acute Myocardial Infarction ◽  
Type 2 Diabetes Mellitus ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Working Age

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.

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