Prognostic Value of Asymmetric Dimethylarginine in the Development of Complications in the Hospital Period of Acute Myocardial Infarction with ST-Segment Elevation in Patients with Type 2 Diabetes Mellitus
Authors:   Kharkiv National Medical University. 4, Nauky Avenue, Kharkiv 61022, Ukraine, Feldman D. А. , Ryndina N. G. ,   Kharkiv National Medical University. 4, Nauky Avenue, Kharkiv 61022, Ukraine, Kravchun P. G. ,   Kharkiv National Medical University. 4, Nauky Avenue, Kharkiv 61022, Ukraine, Krayz I.G. ,   Kharkiv Clinical Hospital by Rail №1. Branch "Health Center" JSC "Ukrzaliznytsia". 5, Balakiyeva Lane, Kharkiv 61018, Ukraine, Zabashta V. F. ,   Municipal Non-Commercial Enterprise of Kharkiv Regional Council Center of the Emergency Medical Care and Medicine of Accidents. 13, Pravdy Ave., Kharkiv 61023, Ukraine
Published: February 2021

The purpose of the study was to determine the prognostic value of asymmetric dimethylarginine in the development of complications in the hospital period of acute myocardial infarction with ST segment elevation in patients with type 2 diabetes mellitus. Material and methods. The study design consisted of 120 patients. They were divided into 2 groups. Group 1 consisted of patients with acute myocardial infarction and concomitant type 2 diabetes mellitus (n=70), group 2 included patients with acute myocardial infarction without concomitant type 2 diabetes mellitus (n=50). Patients of both groups matched on age and sex (60 men (50%) and 60 women (50%); their average age was 66.35±0.91 years, р<0.05). The control group consisted of 20 almost healthy people, among them 12 women (60%) and 8 men (40%) (average age was 45.17±2.88 years). The patients were divided into 3 tertiles according to the level of аsymmetric dimethylarginine (ADMA): ADMA ⩽1.45 μmol/l – 1st tertile; 1.45 μmol/l< ADMA ⩽1.98 μmol/l - 2nd tertile; ADMA >1.98 μmol/l - 3rd tertile. Results and discussion. The obtained results showed that the level of ADMA in patients with acute myocardial infarction in combination with type 2 diabetes was by 2.57 times (p <0.05) higher compared to patients without concomitant type 2 diabetes. In particular, the ADMA level was at 1.57±0.11 μmol/l in patients with acute myocardial infarction in combination with concomitant type 2 diabetes, while in patients with acute myocardial infarction without concomitant type 2 diabetes it was at 0.61±0.06 μmol/l. The ADMA value at >1.13 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes is a predictor of acute left ventricular failure. The ADMA tertiles were used to determine the acute myocardial infarction severity class based on the Killip scale. It is noteworthy that severer classes of acute myocardial infarction on the Killip scale were observed in a patient whose ADMA value belonged to the 3rd tertile group. We determined the ADMA value of A >2.08 μmol/l in patients with acute myocardial infarction in combination with type 2 diabetes, which was a predictor of a life-threatening condition of cardiogenic shock. Conclusion. The asymmetric dimethylarginine exhibits the following predictor properties: in relation to the development of acute left ventricular failure – at >1.13 μmol/l; in relation to the development of cardiogenic shock - at >2.08 μmol/l during the hospital period of acute myocardial infarction with ST-segment elevation in patients with concomitant type 2 diabetes. It is advisable to continue studying the marker of endothelial dysfunction (asymmetric dimethylarginine) as a predictor of adverse myocardial infarction in combination with concomitant type 2 diabetes