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How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

https://doi.org/10.20996/1819-6446-2019-15-1-29-35

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Abstract

The number of elderly patients with diabetes mellitus (DM) is constantly growing in general population. Accordantly, we have the growth of such patients in the group of acute coronary syndrome (ACS).

Aim. To compare clinical characteristics of the elderly patient (>75 years old) with and without DM.

Material and methods. This retrospective study included 1133 ACS patients who were aged ≥75 years and admitted to the City Clinical Hospital №1 from 01.01.2015 to 31.12.2016. Median age was 80 years, 66% were women. We analyzed 4 patient subgroups: Group 1 – 105 patients with ST-segment elevation myocardial infarction (STEMI) and DM, Group 2 – 254 STEMI patients without DM, Group 3 – 222 non-STEMI patients with DM and Group 4 – 552 non-STEMI patients without DM. We used Student’s t-test and c2 tests to find significant difference between pairs of groups.

Results. Median age of patients in 4 groups was 80, 81, 81 and 80 years (p>0.05), age variance was 75-100 years. DM was found in 29% of all elderly patients with no difference between STEMI and non-STEMI groups. STEMI and non-STEMI patients with DM were more likely women. NonSTEMI patients with DM more often had hypertension, previous stroke, lower median Hb (121 vs 127 g/l; p<0.001). Angiography data demonstrated more often three-vessel disease (43% vs 29.7%) and less one-vessel disease (15% vs 25.6%; p<0.05) between groups 3 and 4. Glomerular filtration rate (GFR) <60 ml/min/1.73 m2 occurred in 74%, 73%, 77% and 74% in patients of 4 groups (p>0,05), but GFR<45 ml/min/1.73 m2 was more prevalent in patients with DM than without DM: 45%, 39%, 45%, 36% in 4 groups. Finally, mortality rates didn’t demonstrate significant difference between DM and non-DM patients with STEMI (10% vs 13%; p>0.05) and non-STEMI (7% vs 7%) groups.

Conclusion. DM is associated with ACS approximately in one third of the elderly patients and is not associated with its type (STEMI or non-STEMI). In STEMI and non-STEMI patients the female sex and GFR level <45 ml/min/1.73 m2 were associated with DM. In non-STEMI group multi-vessel disease and presence of hypertension and previous stroke were associated with DM. We didn’t find any difference between mortality in elderly patients with and without DM. 

About the Authors

M. R. Atabegashvili
City Clinical Hospital №1 named after N.I. Pirogov
Russian Federation

MD, Doctor, Cardiology Department,

Leninsky prospect 8, Moscow, 119049



E. V. Konstantinova
City Clinical Hospital №1 named after N.I. Pirogov; Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Associate Professor, Chair of Faculty Therapy named after Acad. A.I. Nesterov, Leninsky prospect 8, Moscow, 119049;

Professor, Chair of Interventional Cardiology and Cardiac Rehabilitation, Ostrovitianova ul. 1, Moscow, 117997



M. D. Muksinova
A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
Russian Federation

MD, Resident, 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 



A. E. Udovichenko
City Clinical Hospital №1 named after N.I. Pirogov; Pirogov Russian National Research Medical University; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Leninsky prospect 8, Moscow, 119049, Head of Department of Interventional Radiology;

Ostrovitianova ul. 1, Moscow, 117997;

MD, PhD, Associate Professor, Chair of Preventive and Emergency Cardiology, Trubetskaya ul. 8-2, Moscow, 119991



A. P. Nesterov
City Clinical Hospital №1 named after N.I. Pirogov Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Head of Regional Cardiovascular Center, Leninsky prospect 8, Moscow, 119049;

Associate Professor, Chair of Interventional Cardiology and Cardiac Rehabilitation, Ostrovitianova ul. 1, Moscow, 117997



M. O. Zheltoukhova
Burnasyan Federal Medical Biophysical Center, Federal Medical Biological Agency
Russian Federation

MD, Resident, 

Marshala Novikova ul. 23, Moscow, 123098



L. S. kyzy Muradova
A.L. Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology
Russian Federation

MD, Resident, 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 



M. Y. Gilarov
City Clinical Hospital №1 named after N.I. Pirogov; Pirogov Russian National Research Medical University; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Deputy Chief Physician for Therapeutic Care, Leninsky prospect 8, Moscow, 119049;

Ostrovitianova ul. 1, Moscow, 117997

Professor, Chair of Preventive and Emergency Cardiology, Trubetskaya ul. 8-2, Moscow, 119991



References

1. Ogurtsova, K., da Rocha Fernandes J.D., Huang Y., et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice. 2017;128:40- 50. doi:10.1016/j.diabres.2017.03.024.

2. Lee P.Y., Alexander K.P., Hammill B.G., et al. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA. 2001;286:708-13. doi:10.1001/jama.286.6.708.

3. Bourgeois F.T., Orenstein L., Ballakur S. et al. Exclusion of elderly people from randomized clinical trials of drugs for ischemic heart disease. J Am Geriatr Soc. 2017;65(11):2354-61. doi:10.1111/ jgs.14833.

4. Gilyarov M.Y., Zheltoukhova M.O., Konstantinova E.V., et al. Тreatment characteristics of acute coronary syndrome in elderly patients: practice of N.I. Pirogov city clinical hospital №1. Rational Pharmacotherapy in Cardiology. 2017;13(2):164-70. (In Russ.). doi:10.20996/1819-6446-2017-13-2-164-170.

5. Levey A.S., Coresh J., Greene T., et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Annals of Internal Medicine. 2006;145(4):247-54. doi:10.7326/0003-4819-145-4-200608150-00004.

6. Erlikh A.D., Gratsiansky N.A. and participants of the RECORD registry. Registry of Acute Coronary Syndromes «RECORD-3». Characteristics of Patients and Treatment During Initial Hospitalization. Kardiologiia. 2016;56(4):16-24 (In Russ.) doi:10.18565/cardio.2016.4.16-24.

7. Alexander K.P., Newby L.K., Cannon C.P., et al. Acute Coronary Care in the Elderly, Part I. Non-ST-Segment-Elevation Acute Coronary Syndromes. A Scientific Statement for Healthcare Professionals from the American Heart Association Council on Clinical Cardiology. In Collaboration With the Society of Geriatric Cardiology. Circulation. 2007;115:2549-69. doi:10.1161/circulationaha. 107.182615.

8. Alexander K.P., Newby L.K., Armstrong P.W., et al. Acute Coronary Care in the Elderly, Part II ST-Segment-Elevation Myocardial Infarction. A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology In Collaboration With the Society of Geriatric Cardiology. Circulation. 2007;115:2570-89. doi:10.1161/circulationaha.107.182616.

9. Googman S.G., Huang W., Yan A.T., et al. Expanded Global Registry of Acute Coronary Events (GRACE2) Investigators. The expanded Global Registry of Acute Coronary Events: baseline characteristics, management practices, and hospital outcomes of patients with acute coronary syndromes. Am Heart J. 2009;158 (2):193-201. doi:10.1016/j.ahj.2009.06.003.

10. Dedov I.I., Shestakova M.V., Vikulova O.K., et al. Diabetes mellitus in russian federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of glucose lowering therapy according to the federal diabetes register, status 2017. Diabetes Mellitus. 2018;21(3):144-59. (In Russ.). doi:10.14341/dm9686.

11. Mandelzweig L., Battler A., Boyko V., et al.; Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006;27(19):2285-93. doi:10.1093/eurheartj/ehl196.

12. Libby P., Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005;111:3481-8. doi:10.1161/CIRCULATIONAHA.105.537878.

13. Campbell I.C., Suever J.D., Timmins L.H., et al. Biomechanics and inflammation in atherosclerotic plaque erosion and plaque rupture: implications for cardiovascular events in women. PLoS ONE. 2004;9(11):e111785. doi:10.1371/journal.pone.0111785.

14. Wu T., Wang L. Angiographic characteristics of the coronary artery in patients with type 2 diabetes. Exp Clin Cardiol. 2002;7(4):199-200.

15. Deedwania P., Prakash T., Kotak K., et al. Compliance with guideline-directed therapy in diabetic patients admitted with acute coronary syndrome: Findings from the American Heart Association's Get with The Guidelines-Coronary Artery Disease (GWTG-CAD) program. Am Heart J. 2017;187:78- 87. doi:10.1016/j.ahj.2017.02.025.

16. Sean M. Diabetes and mortality following acute coronary syndromes. JAMA. 2007;298(7):765- 75. doi:10.1001/jama.298.7.765.


For citation:


Atabegashvili M.R., Konstantinova E.V., Muksinova M.D., Udovichenko A.E., Nesterov A.P., Zheltoukhova M.O., Muradova L.S., Gilarov M.Y. How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice? Rational Pharmacotherapy in Cardiology. 2019;15(1):29-35. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-1-29-35

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