Key result
In STEMI patients with type 2 diabetes, ADMA levels were higher than in those without diabetes (1.57 vs 0.61 μmol/l, p<0.05) and predicted acute left ventricular failure and cardiogenic shock.
Why the study?
The study was conducted to determine the prognostic value of asymmetric dimethylarginine for in-hospital complications in patients with STEMI and concomitant type 2 diabetes mellitus.
Does the level of asymmetric dimethylarginine predict in-hospital complications in patients with acute myocardial infarction and type 2 diabetes mellitus?
Observational (n=140)
Does the level of asymmetric dimethylarginine predict in-hospital complications in patients with acute myocardial infarction and type 2 diabetes mellitus?
Absolute Event Rate: 1.57% vs 0.61%
p-value: p=<0.05
Elevated levels of asymmetric dimethylarginine can serve as a predictor for severe in-hospital complications like acute left ventricular failure and cardiogenic shock in patients with STEMI and type 2 diabetes.
ADMA measurement may refine in-hospital risk stratification in STEMI with T2DM; extends prognostic biomarker data in diabetic MI.
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
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Feldman et al. (2021) conducted an observational in Acute myocardial infarction with ST-segment elevation and type 2 diabetes mellitus (n=140). Asymmetric dimethylarginine (ADMA) vs. Patients without type 2 diabetes was evaluated on ADMA level (p=<0.05). In STEMI patients with type 2 diabetes, ADMA levels were higher than in those without diabetes (1.57 vs 0.61 μmol/l, p<0.05) and predicted acute left ventricular failure and cardiogenic shock.
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