The Value of Combining Plasma D-Dimer and Endothelin-1 Levels to Predict No-Reflow After Percutaneous Coronary Intervention of ST-Segment Elevation in Acute Myocardial Infarction Patients with a Type 2 Diabetes Mellitus History

Background: Visceral adiposity index (VAI), a surrogate marker of adiposity and insulin resistance, has been demonstrated to be significantly related to cardiovascular disease. It remains indistinct whether VAI predicts adverse prognosis after percutaneous coronary intervention (PCI) for patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and type 2 diabetes mellitus (T2DM).Methods: A total of 798 participants who met the enrollment criteria were finally brought into this study. VAI was determined by waist circumference, body mass index, fasting triglyceride, and high-density lipoprotein cholesterol as previously reported. Adverse prognosis included all-cause death, non-fatal myocardial infarction, non-fatal ischemic stroke, and ischemia-driven revascularization, the composite of which was defined as the primary endpoint.Results: Higher VAI maintained as a significant and independent risk predictor for the primary endpoint, regardless of the adjustment for the various multivariate models [hazard ratio (95% CI) for fully adjusted model: 2.72 (2.02–3.68), p < 0.001]. The predictive value of VAI was further confirmed in sensitivity analysis where VAI was taken as a continuous variate. There was a dose-response relationship of VAI with the risk of the primary endpoint (p for overall association < 0.001). Moreover, the ability of VAI on the prediction of the primary endpoint was consistent between subgroups stratified by potential confounding factors (all p for interaction > 0.05). VAI exhibited a significant incremental effect on risk stratification for the primary endpoint beyond existing risk scores, expressed as increased Harrell's C-index, significant continuous net reclassification improvement, and significant integrated discrimination improvement.Conclusion: VAI is a significant indicator for predicting worse prognosis and plays an important role in risk stratification among patients with NSTE-ACS and T2DM undergoing elective PCI. The present findings require further large-scale, prospective studies to confirm.

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Prognostic Value of Asymmetric Dimethylarginine in the Development of Complications in the Hospital Period of Acute Myocardial Infarction with ST-Segment Elevation in Patients with Type 2 Diabetes Mellitus

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.01.145 ◽

2021 ◽

Vol 6 (1) ◽

pp. 145-152

Author(s):

D. А. Feldman ◽

◽

N. G. Ryndina ◽

P. G. Kravchun ◽

I.G. Krayz ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Type 2 Diabetes ◽

Acute Myocardial Infarction ◽

Type 2 Diabetes Mellitus ◽

Asymmetric Dimethylarginine ◽

Left Ventricular ◽

St Segment Elevation ◽

St Segment

The purpose of the study was to determine the prognostic value of asymmetric dimethylarginine in the development of complications in the hospital period of acute myocardial infarction with ST segment elevation in patients with type 2 diabetes mellitus. Material and methods. The study design consisted of 120 patients. They were divided into 2 groups. Group 1 consisted of patients with acute myocardial infarction and concomitant type 2 diabetes mellitus (n=70), group 2 included patients with acute myocardial infarction without concomitant type 2 diabetes mellitus (n=50). Patients of both groups matched on age and sex (60 men (50%) and 60 women (50%); their average age was 66.35±0.91 years, р<0.05). The control group consisted of 20 almost healthy people, among them 12 women (60%) and 8 men (40%) (average age was 45.17±2.88 years). The patients were divided into 3 tertiles according to the level of аsymmetric dimethylarginine (ADMA): ADMA ⩽1.45 μmol/l – 1st tertile; 1.45 μmol/l< ADMA ⩽1.98 μmol/l - 2nd tertile; ADMA >1.98 μmol/l - 3rd tertile. Results and discussion. The obtained results showed that the level of ADMA in patients with acute myocardial infarction in combination with type 2 diabetes was by 2.57 times (p <0.05) higher compared to patients without concomitant type 2 diabetes. In particular, the ADMA level was at 1.57±0.11 μmol/l in patients with acute myocardial infarction in combination with concomitant type 2 diabetes, while in patients with acute myocardial infarction without concomitant type 2 diabetes it was at 0.61±0.06 μmol/l. The ADMA value at >1.13 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes is a predictor of acute left ventricular failure. The ADMA tertiles were used to determine the acute myocardial infarction severity class based on the Killip scale. It is noteworthy that severer classes of acute myocardial infarction on the Killip scale were observed in a patient whose ADMA value belonged to the 3rd tertile group. We determined the ADMA value of A >2.08 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes, which was a predictor of a life-threatening condition of cardiogenic shock. Conclusion. The asymmetric dimethylarginine exhibits the following predictor properties: in relation to the development of acute left ventricular failure – at >1.13 μmol/l; in relation to the development of cardiogenic shock - at >2.08 μmol/l during the hospital period of acute myocardial infarction with ST-segment elevation in patients with concomitant type 2 diabetes. It is advisable to continue studying the marker of endothelial dysfunction (asymmetric dimethylarginine) as a predictor of adverse myocardial infarction in combination with concomitant type 2 diabetes

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