Zaikina T. Optimization of the diagnostics and treatment of patients with acute myocardial infarction and concomitant type 2 diabetes mellitus based on the evaluation of endothelial damage markers and insulin resistance.

Thesis is dedicated to increasing effectiveness of diagnostics and treatment of patients with ST-elevated acute myocardial infarction and concomitant type 2 diabetes based on the assessment of the endothelial damage markers - sVE-cadherin, sCD40-ligand, von Willebrand factor - and insulin resistance and the possibility of their use for the prediction of complications in acute period of ST-elevated myocardial infarction and the occurrence of adverse endpoint (cardiovascular death, recurrent myocardial infarction, unstable angina, repeated hospitalization) during the year after myocardial infarction. The study included 125 patients with ST-elevated AMI and 12 patients with stable angina. The patients were divided into groups: basic group - patients with ST-elevated acute myocardial infarction and concomitant type 2 diabetes (n=70), 1 control group - patients with ST-elevated acute myocardial infarction without type 2 diabetes (n=55), 2 comparison group - patients with stable angina without disturbances of carbohydrate metabolism (n=12). The control group consisted of 12 healthy individuals. The average age of patients with ST-elevated acute myocardial infarction and concomitant type 2 diabetes was 68,37±1,22 years, and patients with ST-elevated acute myocardial infarction without disturbances of carbohydrate metabolism - 64,50±1,32 years. The study shows a significant increasing of sVE-cadherin, sCD40-ligand, von Willebrand factor levels in patients with ST-elevated acute myocardial infarction and concomitant diabetes type 2 diabetes mellitus, which indicates the endothelium damage in acute occlusion of the coronary artery. It demonstrated the direct role of platelet-leukocyte interactionб immune inflammation and the disintegration of the endothelial monolayer in the destabilization of atherosclerotic plaque formation and development of thrombotic complications. Using of the fibrinolysis in patients with diabetes mellitus type 2 is associated with a significant reduction of endothelial damage markers in ST-elevated acute myocardial infarction than patients who did not get fibrinolysis. It indicates that fibrinolityc therapy improves the endothelial recovery. Using of metformin as a part of standart therapy in patient with acute myocardial infarction and type 2 diabetes was associated with faster decreasing of sCD40-ligand and von Willebrand factor levels. The prediction model of hospital mortality in the patients with ST-elevated acute myocardial infarction and type 2 diabetes mellitus was elaborated and prognostic markers of adverse endpoints in patients with diabetes mellitus type 2 during the year after myocardial infarction were established.