DOI: https://doi.org/10.22141/2224-0721.14.8.2018.154859

Acute stent thrombosis in myocardial infarction complicated by cardiogenic shock in the presence of type 2 diabetes mellitus

Yu.H. Kyyak, O.Ye. Labinska, M.P. Halkevych, O.Yu. Barnett, H.Yu. Kyyak, V.I. Kovalyshyn

Abstract


Background. Acute stent thrombosis is a rare, but life­threatening complication of coronary stenting. It occurs during percutaneous coronary intervention or within 24 hours after this procedure. The purpose of the study was to find out the causes and analyze the factors that led to acute stent thrombosis in patients with acute coronary syndrome and type 2 diabetes mellitus (DM) in order to avoid such complications. Materials and methods. There were 119 patients with acute ST­segment elevation myocardial infarction. They were treated in the cardiology unit of the Municipal Non­Profit Enterprise “Lviv Clinical Emergency Hospital”. All patients were treated using coronary angiography and coronary stenting. An ultrastructural study of venous blood platelets was performed using electron microscopy. Results. Patients with type 2 DM have a higher cardiovascular risk of cardiovascular complications associated with endothelial dysfunction and risk of hypercoagulation and, as a consequence, a tendency towards vasoconstriction, inflammatory reactions, and hemostatiс disorders. In these patients, there is an increased platelet adhesion and an increased concentration of tissue plasminogen activator. During express necropsy and perioperative biopsy of myocardium in patients with DM, we identified the dominance of hypercoagulation in myocardial microvessels as a result of the activity of the blood coagulation system in the absence of direct involvement of the platelets, since some of them were calcified and had reduced functional capacity, and therefore, resistance to aspirin was detected. Persons with type 2 DM usually have severe and more generalized coronary sclerosis, which leads to a more severe course of acute coronary syndrome and a more frequent occurrence of stent thrombosis, which makes expedient the additional prescription of rivaroxaban. Conclusions. Given the signs of decreased platelet reactivity, the dominance of activated coagulation system in patients with DM and an increased risk of coronary artery disease, the use of new oral anticoagulants is relevant and deserves further research.


Keywords


type 2 diabetes mellitus; acute stent thrombosis; myocardial infarction; percutaneous coronary intervention; platelet aggregation

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