THE INFLUENCE OF CYTOPROTECTIVE AND METABOLIC THERAPY ON THE DYNAMICS OF QUALITY OF LIFE INDICATORS IN PATIENTS WITH STEMI THAT DEVELOPED AGAINST THE BACKGROUND OF TYPE 2 DIABETES

Abstract

SUMMARY. The presence of type 2 diabetes in patients with acute coronary syndrome (ACS) limits the possibility of using early invasive coronary interventions and determines the tactics of drug preparation for surgical interventions and prevention of complications. The severity of the clinical and psychoemotional state of such patients substantiates the importance and feasibility of assessing the integral indicator of "quality of life" as criterion of effectiveness and expediency of carried out medical measures.

The aim – to evaluate the dynamics of quality of life indicators using the Euroqol Group EQ-5D-5L questionnaire in patients with ACS (STEMI) on the background of type 2 diabetes and a high risk of developing cardiac complications at the inpatient stage of treatment under the influence of metabolic (SGLT2 inhibitor dapagliflozin) and cytoprotective (L-carnitine) therapy.

Material and Methods. 75 patients with ACS (STEMI) on the background of T2DM were examined: 38 patients of the main group, who underwent urgent balloon angioplasty and stenting of the infarct-related coronary artery, additionally received L-carnitine and dapagliflozin. 37 patients of the comparison group received only standard protocol treatment. The control group consisted of 28 patients with STEMI without comorbid pathology, who also underwent urgent coronary angioplasty, stenting, and protocol drug treatment. In addition to general clinical, laboratory, and instrumental methods, patients were additionally monitored by ECG, transthoracic echocardiography, and CAG to assess the severity of VA damage, and quality of life was determined using the EQ-5D-5L questionnaire.

Results. In the initial state, the severity of the clinical condition in patients of both groups did not differ significantly and was caused by typical manifestations of ACS and T2DM. In patients of the main group, the additional use of L-carnitine and dapagliflozin against the background of protocol treatment led to 100 % elimination of anginal syndrome and decrease in FC GOS to I-II. In the patients of the comparison group, after 5 days, chest discomfort was observed (in 53.1 %) and GOS Killip class II–III in 50.0 % of patients. The dynamics of troponin and creatine phosphokinase indicators in patients of both studied groups indicated the cessation of cardiomyocyte necrosis already in the first days of treatment. But in patients of the comparison group, their levels did not reach the reference norm even on the fifth day. It was also established that the clinical effectiveness of the complex treatment was significantly higher in relation to reperfusion rhythm disturbances and manifestations of acute heart failure, which were registered respectively in 13.3 % of patients in the main group versus 32.1 % in the control group, and ventricular tachycardia and ventricular fibrillation developed in them 3 times less often

At baseline, patients of both studied groups rated their quality of life with a relatively low score (25.83±10.37) points and (26.24±10.18) points. In the process of carrying out a standard treatment program, patients with ACS in combination with T2DM experienced a significant improvement in well-being, the quality of life index increased by 70.2 % in general. At the same time, we note a significantly higher assessment of the quality of life in patients after a course of complex treatment with the inclusion of L-carnitine and dapagliflozin. Their quality of life index improved by an average of 238.6 % and reached the level of (87.5±9.4) units. With the additional use of L-carnitine and dapagliflozin, the best results were obtained in terms of patient ratings of reduced chest pain/discomfort and feelings of anxiety/depression and slightly lower motor activity scores. At the same time, the use of standard treatment was accompanied by a reliable regression of only the pain syndrome indicator, but the severe general clinical condition of the patients in this group contributed to the increase in signs of anxiety and depressive behavior at the end of the inpatient course of treatment.

Conclusions. The use of a course of complex medical therapy with the inclusion of L-carnitine and dapagliflozin in the pre- and postoperative periods in patients with ACS in combination with T2DM led to an improvement in the clinical condition, restoration of central and peripheral cardiohemodynamic parameters, and a significant reduction in the frequency of reperfusion arrhythmias and left ventricular failure. At the same time, the patients of this group obtained the best results in terms of their assessment of the reduction of chest pain/discomfort and the feeling of anxiety/depression and slightly lower in terms of motor activity, and the use of standard treatment was accompanied by only a reliable regression of the pain syndrome index, but the severe general clinical condition of the patients contributed to the increase of symptoms anxiety and depressive behavior.