Acute myocardial infarction in patients with diabetes mellitus: possibility and expediency of cardioprotection

The aim — to evaluate the efficacy and safety of addition of a solution containing 4.2 g of arginine hydrochloride and 2.0 g L‑carnitine to standard therapy of patients with acute coronary syndrome (ACS) with ST segment elevation and concomitant type 2 diabetes mellitus (DM) after revascularization through primary coronary intervention (PCI). Materials and methods. The study involved 60 patients (mean age 64.3 ± 1.6 years) with ACS with ST segment elevation of up to 6 hours’ duration and concomitant type 2 DM, who had had urgent coronary angiography and stenting of the infarction‑dependent artery. The patients were divided into two groups: group І — 30 persons to whom standard intravenous infusion was given of a preparation containing 4.2 g of arginine hydrochloride and 2.0 g of L‑carnitine, 100 ml a day for 7 days, and group ІІ — 30 individuals who did not receive additional therapy. A general clinical examination was conducted with an assessment of complaints and anamnesis, objective physical examination data and the results of additional diagnostic methods. The level of troponin I and resolution of ST segment were determined on the 1st, 3rd and 7th days. Results and discussion. Patients in both groups were compared according to the main clinical and anthropometric indices, prescribed drug therapy, features of atherosclerotic damage of coronary artery, duration of ischemic period, troponin I level on the 1st, 3rd and 7th days (all p > 0.05). The value of ST segment elevation at the time of hospitalization in the patients of both groups did not differ significantly: 4.8 ± 0.17 and 4.5 ± 0.15 mm respectively, but on day 3 it was lower in group І (2.37 ± 0.14 mm) compared with group II 3.2 ± 0.17 mm, p = 0.05). In patients of group I, unlike such of group II, there was a significant decrease in the level of aspartate aminotransferase and alanine aminotransferase on day 7. The decrease in group I was more pronounced than in group II (p = 0.048 and p = 0.032, respectively). Conclusions. The addition of amino acids complexes (4.2g of arginine hydrochloride and 2.0 g of L‑carnitine) to drug therapy of patients with ACS with ST segment elevation and concomitant DM type 2 after myocardial revascularization, contributes to a rapid decrease in the level of troponin I and reduction in ST segment elevation and is not accompanied by side effects.