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Prognosis of the Patients with Non ST Elevation Acute Coronary Syndrome Associated with Diabetes Mellitus Type 2 during Follow-up


Author: Ţurcanu Veronica
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2008
Scientific adviser: Aurel Grosu
doctor habilitat, professor, Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Scientific consultant: Zinaida Anestiadi
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 7 December, 2007
Approved by NCAA on the 24 January, 2008

Abstract

Adobe PDF document0.46 Mb / in romanian

Thesis

CZU 616.132.2 – 008.6 – 06:616.379 – 008.64 - 07

Adobe PDF document 2.15 Mb / in romanian
136 pages


Keywords

prognostic, acute coronary syndrome with non-ST-segment elevation, diabetes mellitus, cardiovascular risc, GRACE scor

Summary

In this study were included 140 patients with non ST elevation acute coronary syndrome, of witch 70 patients were with diabetes mellitus type 2. The average age of these patients was of 61,2 ± 0,75 years and also diabetics were older. Men predominated both in diabetic as in non diabetic groups of patients, although diabetic women developed acute coronary events two times more then men.

Diabetic patients with acute coronary syndrome on arrival to hospital had frequently atypical chest pain, silent ischemia, ST-segment depression > 2mm, acute heart failure (pulmonary edema).

Diabetic patients presented a higher prevalence of hypertension, dyslipidemia, and previous myocardial infarction.

The evolution of the acute coronary syndrome during hospital staying was marked by recurrent chest pain with ST-segment depression, a longer hospitalization and a higher mortality.

Exercise testing turned to be a valuable method for the assessment of the patients’ prognosis with acute coronary syndrome. Also this method was limited by the recurrent chest pain and myocardial ischemia, diabetes mellitus complications.

The findings of coronary angiography pointed out severe multi-vessel disease that was significantly more frequent in diabetic patients.

During 15,7 months of follow-up the patients included in the study had cardiovascular complications (acute myocardial infarction, atrial fibrillation, stroke and mortality) especially the patients with diabetes mellitus.

Calculation of the GRACE risk scores helped to classify the patients into some groups according to the cardiovascular risk. Thus, the diabetic patients were classified in those with medium and high risk, nondiabetic into those with low and medium risk for in hospital and follow-up mortality.

Diabetes mellitus duration influences the evolution of the acute coronary syndrome. A longer duration of diabetes mellitus determines a poor prognosis of the patients with ACS.

Glycaemia determined at the arrival at the hospital also influences the prognosis of the diabetic with acute coronary syndrome. For the patients with higher values of glicaemia was noted a higher mortality rate and more cardiovascular complications.

Prognosis of non ST elevation ACS among diabetic patients is poorer than among nondiabetics during the follow-up.