Koteliukh M. The role of matrix metalloproteinases and tenascin C in the patients with acute myocardial infarction and diabetes mellitus type 2.

The thesis is devoted to the improvement of the efficiency of diagnosis and treatment of patients with acute myocardial infarction and concomitant diabetes mellitus type 2 according to the level of extracellular matrix markers, particularly matrix metalloproteinase - 13, tissue inhibitor metalloproteinase - 4, tenascin C and the possibility of their employment for predicting the development of adverse complications of acute myocardial infarction. The study involved examination of 110 patients with acute myocardial infarction. All the patients were divided into the following groups: the main group comprised patients with acute myocardial infarction and concomitant diabetes mellitus type 2 (n=70), the comparison group included patients with acute myocardial infarction without diabetes mellitus type 2 (n=40). The control group consisted of 20 practically healthy persons. The average age of patients with acute myocardial infarction and concomitant diabetes mellitus type 2 was 64.3±3.5 years, and the average age of those with acute myocardial infarction without type 2 diabetes mellitus was 64.3±3.5 years. The patients were further divided into 4 subgroups for comparative evaluation of the therapeutic effect: the first subgroup of patients with acute myocardial infarction and diabetes mellitus type 2, who also underwent stent implantation (n=15); the second subgroup of patients with acute myocardial infarction and diabetes mellitus type 2, who underwent standard anticoagulant therapy (n=55); the third subgroup of patients with acute myocardial infarction without diabetes mellitus type 2, who underwent additional stenting (n=20); the fourth subgroup of patients with acute myocardial infarction without diabetes mellitus type 2, who underwent standard anticoagulant therapy (n=20). The study showed a significant increase in matrix metalloproteinase - 13, tissue inhibitor of metalloproteinase - 4, tenascin C on day 1 - 2 in patients with acute myocardial infarction with concomitant diabetes mellitus type 2, which indicated an imbalance in the system of intercellular matrix parameters. Stent implantation in patients with diabetes mellitus type 2 was found to result in a more significant decrease in the levels of intercellular matrix values on the 10 - 14th day of acute myocardial infarction than in the patients, who have undergone standard anticoagulant therapy, which indicated an acceleration of myocardial repair after the revascularization. The study allowed to elaborate models for predicting left ventricular systolic dysfunction, development of left ventricular failure, hospital mortality during the acute period of myocardial infarction by stratification of high and low risk patients.