Alghzawi I. Clinical and pathogenetic patterns of acute coronary syndrome course and efficacy of its management depends of the risk factors

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

State registration number


Applicant for


  • 222 - Медицина


Specialized Academic Board

ДФ 20.601.025

Ivano-Frankivsk national medical university


It is noted that the course of acute coronary syndrome on the background of type 2 diabetes mellitus is characterized by a higher frequency of detection of multivascular damage to the coronary arteries; high probability of developing an atypical onset of myocardial infarction (φ = + 0.29); concomitant chronic kidney disease; higher risk of adverse cardiovascular events on the GRACE scale (by 14.5 %); increase in leukocytes count in the blood (by 19.1 %), mainly due to neutrophils (by 22.2 %); the level of C-reactive protein (12.5 %); a marked decrease in the ejection fraction of the left ventricle (by 13.9%), low quality of life (by 21.8%). The association of chronic kidney disease and higher risk on the GRACE scale (φ = + 0.28) was revealed; HbA1c content and higher risk on the GRACE scale (φ = + 0.37); a moderate relationship between the number of blood leukocytes count and multivascular damage (φ = + 0.33); verified medium-strength direct relationship between troponin I content and PSA levels (rs = 0.41; p <0.05). Acute coronary syndrome in patients with a combination of hypertension and type 2 diabetes mellitus is characterized by: higher risk of severe acute heart failure according to Killip class (φ = + 0.24) and adverse cardiovascular events on the GRACE scale (20.2%); increase in blood creatinine level (by 9.9 %); the number of leukocytes, mainly due to neutrophils (21.5 %); high titers of C-reactive protein (15.8 %); low ejection fraction of left ventricle (by 11.1 %); worse quality of life (by 20.0 %). At the same time, a direct correlation was observed between the EF and the plasma creatinine level (r = 0.41), and the inverse correlation between the EF and the duration of the QRS complex (rs = 0.39; p <0.05) was observed. There is a moderate relationship between the level of C-reactive protein and the leukocytes count (r = 0.43; p <0.05). It is established that in case of multivascular damage in acute coronary syndrome the most significant changes in the structural and functional state of the myocardium occurs, which is characterized by an increase in the size of the left atrium, average values of EDD, ESD, EDV and ESV. At the same time, in such patients the lowest LV EF was observed - (44.88 ± 1.99) %. The association between the content of C-reactive protein (φ = + 0.37), as well as the levels of NTproBNP (φ = + 0.25) in the blood of patients with acute coronary syndrome with concomitant type 2 diabetes mellitus and the likelihood of multivascular damage were established. The main prognostic signs of the risk of probability and manifestations of multivascular injury in patients with acute coronary syndrome are: increase in age (HR = 1,027 (95 % CI, 1,011-1,051; p <0,001)) concomitant hypertension (HR = 2,431 (95 % CI, 1,497) -4,145; p <0,001)) or type 2 diabetes mellitus (HR = 2,756 (95 % CI, 1,568-4,287; p <0,001)), blood HbA1c level (HR = 5,451 (95 % CI, 2,998-9,718; p) <0,001)) or NT-pro-BNP level (HR = 1,247 (95 % CI, 1,063-1,489; p = 0,01)), as well as a higher GRACE score (HR = 1,049 (95 % CI, 1,031- 1.055; p <0.001)). Additional administration of trimetazidine (at a dose of 35 mg twice a day for at least 28 days) in patients with acute coronary syndrome causes a more significant reduction of pain and reduced need for short-acting nitrates; potentiates the reduction of blood levels of prandial glucose in the presence of concomitant diabetes mellitus (OR = 0.114 (95% CI; 0.035-0.578)) or its combination with hypertension (OR = 0.118 (95 % CI; 0.027-0.541)); has anti-inflammatory pleiotropic effects (marked decrease in the number of leukocytes count, due to neutrophils, and the level of C-reactive protein (OR = 0.219 95 % CI; 0.108-0.448)); has an additive effect on reducing serum levels of NT-pro-BNP; definitely improves the quality of life. Key words: myocardial infarction, myocardial conditioning, fibrosing, myocardial remodeling. Branch-Medicine.


Similar theses