Kyyak H. Peculiarities of clinical flow and cellular mechanisms of myocardial injury in patients with acute coronary syndrome and comorbid type 2 diabetes mellitus

The dissertation is based on the results of a prospective clinical study of 201 patients with acute coronary syndrome (ACS) as well as both prospective and retrospective ultrastructural study of 57 cases of ACS and comorbidity type 2 diabetes mellitus. The peculiarities of clinical manifestations, functional performance of the heart, state of coronary arteries and cellular remodeling of the myocardium in patients with different forms of ACS and comorbidity type 2 diabetes mellitus were revealed. Additional scientific evidence about increased levels of pro-inflammatory cytokines (IL-6, IL-8, TNF-alfa) and their performance was revealed. The aforementioned is the cause of a worse prognosis of ACS in type 2 diabetes patients. We found that one-year survival of patients with STEMI and type 2 diabetes comorbidity have a tendency to reduction compared to those without diabetes (cumulative proportion of survivors was 84.0 % versus 93.2 %, respectively, p>0,05). We managed to get calculation model of individual one-year survival of patients with STEMI and concomitant type 2 diabetes. In particular, the probability of death in these patients is increased by the presence of the following factors: episodes of acute heart failure (III-IV classes by Killip), reduced left ventricular ejection fraction, high performance HbA1c and heart rate as well as decline in the heart rate variability - SDNN (sensitivity 87.5 %, specificity 97.6 % and accuracy - 96.0 %). We confirmed the importance of ultrastructural identification of cardiomyocite hibernation in the cases of ACS and concomitant type 2 diabetes mellitus to provide the most efficient medical and surgical treatment in this category of patients.