Diabetes management in acute coronary syndrome

Received May 7; Accepted Dec 8.

Introduction

Copyright © The Author s. This article has been cited by other articles in PMC. Mannose-binding lectin MBL is known to have effect on the progression of atherosclerosis.

diabetes management in acute coronary syndrome

Our aim was to identify the association of these polymorphisms of the MBL gene in the occurrence of in-stent restenosis after coronary artery bare metal stent implantation. Methods In a non-randomized prospective study venous blood samples were collected after recoronarography from patients with prior BMS implantation.

Patients were assigned to diffuse restenosis group and control group based on the result of the coronarography.

diabetes management in acute coronary syndrome

Proportion of different genotypes was compared and adjusted with traditional risk factors using multivariate logistic regression. Results Average follow-up time was 1. The age, gender distribution and risk status was not different between study groups. Proportion of the MBL variant genotype was Conclusions MBL polymorphisms are associated with higher incidence of development of coronary in-stent restenosis.

The attenuated protein function in the mutant allelic genotype may represent the underlying mechanism.

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Keywords: In-stent restenosis, MBL genetic variant, Bare metal stent, Gene association, Cardiology Background Coronary interventions revolutionised the treatment of acute and stable forms of coronary artery disease CAD [ 1 ].

Coronary stents were designed to lower the rate of early restenosis. The most common complications of stent implantation are stent thrombosis and in-stent restenosis ISR.

While stent thrombosis is known to be associated with thrombocyte function, ISR is associated with endothel proliferation. With the use of drug eluting stents DES or other modern stents designed to lower the ratio of endothel proliferation, restenosis ratio could be further reduced.

Risk factors for in-stent restenosis could be classified in two groups.

Acute Coronary Syndrome DETAILED Overview (MI, STEMI, NSTEMI)

Procedural-dependent or local factors are: diameter of vessel, length of lesion or stent, minimal lumen diameter before and after stenting, ostial lesions, stent fracture, total occlusions [ 4 ]. The other group consists of patient-dependent or general factors.

Risk for restenosis is particularly high among patients with diabetes mellitus, this may be associated with metabolic alterations that promote endothelial dysfunction [ 5 ], accelerate intimal hyperplasia [ 6 ], and increased platelet aggregability and thrombogenicity.

There is evidence that gender itself female predisposes to restenosis, and some patients may have a genetically higher risk [ 7 ].

diabetes management in acute coronary syndrome

Genetic polymorphisms associated with high risk for restenosis include polymorphisms in genes coding for angiotensin-converting enzyme inhibitor [ 89 ], glycoprotein receptor IIIa [ 10 ] and haptoglobin [ 11 ].

The former type is determined by local and procedural factors, while the latter shows a significant relationship with general, patient-related factors [ 13 ]. Mannose-binding lectin Mannose-binding lectin MBL is an acute phase protein produced by the liver as part of the innate immune system.

It also has a direct diabetes management in acute coronary syndrome effect by binding to cell-surface receptors on phagocytes.

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It is present in the blood serum forming a complex with serine proteases [ 1415 ]. Functioning alleles show an association with the serum level of MBL protein. Single nucleotide polymorphisms SNP in exon 1 concerning the promoter region of the MBL2 gene are known to reduce the amount of functional MBL subunits 5- to fold, resulting in lower serum levels of MBL: at codon 52 arginine to cysteine, allele Dcodon 54 glycine diabetes management in acute coronary syndrome aspartic acid, allele B, and codon 57 glycine to glutamic acid, allele C.

These variant alleles are commonly named as O, and the normal allele has been named A [ 19 ]. Methods Subjects, interventions and follow-up In our non-randomized prospective study, we investigated patients who had re-coronarography in the Heart and Vascular Center, Semmelweis University between and due to symptoms of non-acute cardiac event stable, instable or effort cukorbetegség kezelésére színterápia pectoris or acute coronary syndrome.

diabetes management in acute coronary syndrome

All patients received standard therapy according to the actual guidelines. A total number of patients 83 men Biological samples and genotyping Total genomic deoxyribonucleic acid DNA was extracted from EDTA-anticoagulated blood samples collected after the second coronarography using the method of Miller et al.

Determination of the alleles of the MBL2 gene at codons 52 D - rs54 B - rsand 57 C - rs were performed by polymerase chain reaction using sequence-specific priming. The common designation for these variant alleles is O, whereas the normal allele has been named A [ 19 ]. Categorical variables were reported as absolute numbers and percentages, and continuous variables as medians and interquartile ranges.

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We used the t-test to compare continuous variables between groups, whereas for continuous nonparametric variables we used the Mann—Whitney U-test. Categorical values were compared by kezelése furuncoolose diabetes the chi-square test. Results Patient characteristics The average follow-up time was 2.

According to this diffuse restenosis occurred and caused symptoms earlier while controls had a longer asymptomatic period before re-coronarography was performed.

diabetes management in acute coronary syndrome

Clinical baseline characteristics of the patients are described in Table 1dividing study participants in two groups. The mean age control: Table 1.

diabetes management in acute coronary syndrome

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