Đái tháo đường týp 2 có tác động đến NMCT ST chênh lên

Young Researcher Contest DOES TYPE DIABETES MELLITUS INFLUENCE CHARACTERS OF PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION Tuan Ho Anh, Tien Hoang Anh Hue University Hospital CONTENT BACKGROUND SUBJECTS AND METHODS RESULTS - DISCUSSION CONCLUSIONS PROPOSAL CONTENT Globally: >3 mil STEMI subjects , mil NSTEMI subjects Viet Nam[1] 9.1% 4.2% American [2] 635000 new AMI 280000 recurrent MI 150000 silent MI France 100000 AMI [1] Đại học Y Hà Nội (2012), Bài giảng bệnh học nội khoa, Tập 1, NXB Y học, Hà Nội, tr 185 [2] Kushner F.G., Hand M., smith S.C et al (2009), "2009 Focused updates: ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction and ACC/AHA/SCAI guidelines on percutaneous coronary intervention", Circulation 2009, Vol 120, pp 2271-2306 BACKGROUND 2-4 folds MI Viet Nam (2002-2012): 2.7%-5.42% 60% undiagnosed [1] [1] Central Endocrinology hos;ital (2012), “Kết hoạt động điều tra đồ dịch tễ học bệnh Đái tháo đường toàn quốc năm 2012 xây dựng công cụ đánh giá mức độ nguy mắc bệnh đái tháo đường dành cho người Việt Nam”, Hội nghị khoa học nội tiết chuyển hóa tồn quốc lần thứ VII, tr 23 • The more expansive International Diabetes Foundation (IDF) Atlas defnition—which, in addition to fasting plasma glucose (FPG) as in the GBD study, includes oral glucose tolerance and HbA1c tests—found that 366 million people had diabetes in 2011 By 2030, the number of people with diabetes is expected to increase to 522 million 522 mil/2030 366 Mil /2011 BACKGROUND GLUCOSE LOWERING AND VASCULAR BENEFITS • Older trials • Recent trials demonstrating a positive demonstrating a impact of tight glycemic neutral/negative impact control on of tight glycemic control macrovascular diseases: on T2DM patients: - DCCT/ERIC - UKPDS - PROACTIVE - ACCORD - ADVANCE - VADT BACKGROUND How is the correlation between diabetes mellitus and STEMI? ? Does DM influence on STEMI - related mortality rate? BACKGROUND Compare clinical, laboratory parameters obtained From acute and subacute STEMI patients with and without diabetes mellitus OB JEC TIVES Evaluate several characters that are valuable for mortality prognosis within 07 days since hospitalization SUBJECTS AND METHODS - Age ≥18 - Admission to Cardiovascular department, Hue University hospital - Diagnosed STEMI (using Third Universal consensus 2012 1/2013 - Patient profiles recorded in hospital: on admission and days thereafter 1/2015 10 GENERAL RESULTS ANDFEATURES DISCUSSION Right Ventricle Thất phải 6.25% 16.13% Thành Inferior region 33.75% Non DM không ĐTĐ DM ĐTĐ p >0.05 22.58% 60.00% Thành trước bên cao Anterior or lateral region 61.29% 20 40 60 80 Chart Site of myocardial infarcction on ECG Analogous to Abass F [1], Iqbal M.J [2] Hung Phạm Văn [3]: LAD 46.3%, RCA 35.9% [1] Abass F., Mufti T.A., Hafizullah M et al (1999), "Effect of diabetic status on morbidity and mortality following acute myocardial infarction", Journal of Postgraduate Medical Institute, Vol 13(1), pp 125-131 [2] Iqbal M.J., Rauf M.A., Faheem M et al (2008), "Study on ST-Segment elevation acute myocardial infarction in diabetic and non diabetic patients", Pak J Med Sci., Vol 24(6), pp 786-791 [3] Phạm Văn Hùng, Hồ Văn Phước, Nguyễn Quốc Việt cs (2014), "Đánh giá kết chụp can thiệp động mạch vành qua da bệnh viện Đà Nẵng",Tạp chí Tim mạch học Việt Nam, Số 68, tr 117-122 26 RESULTS AND DISCUSSION Table Cardiac enzymes concentration by study groups Mean CK (U/L) DM Median SD Bottom Upper Quartile Quartile 1242.19 636.00 1376.59 230.00 1430.75 Non DM 1933.83 1125.5 2300.8 272.00 2512.00 CKMB DM 63.54 26.42 88.75 6.62 79.60 (ng/mL) Non DM 131.36 59.75 145.75 8.99 218.50 27 GENERAL RESULTS ANDFEATURES DISCUSSION Chart Dyslipidemia phenostypes DM DM Total n = 31 n = 80 n = 111 Normal , n (%) (16.13) 10 (12.50) 15 (13.51) TG alone +/- HDL-c alone, n (%) (25.81) (10.00) 16 (14.41) Dyslipidemia phenotype LDL-c alone +/- TC , n (%) (16.13) 24 (30.00) 29 (26.13) Mixed disorder, n (%) 13 (41.93) 38 (47.50) 51 (45.95) P >0.05 28 RESULTS RESULTS AND DISCUSSION Table correlation between clinical and laboratory factors and death within days since admission Variable P OR 95% CI Age ≥60 ys 0.69 Gender 0.52 Smoking 0.57 Diabetes mellitus