acute myocardial infarction
type 2 diabetes mellitus
endothelial dysfunction
asymmetric dimethylarginine
plasminogen activator inhibitor type 1
percutaneous coronary intervention

How to Cite

Minukhina, D. V., Kravchun, P. G., Minukhin, D. V., Yevtushenko, D. A., Kritsak, V. V., & Tkachenko, V. V. (2024). DYNAMICS OF THE LEVELS OF ASYMMETRIC DIMETHYLARGININE AND PLASMINOGEN ACTIVATOR INHIBITOR TYPE 1 IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION AND TYPE 2 DIABETES MELLITUS DEPENDING ON THE REPERFUSION STRATEGY. Clinical and Preventive Medicine, (1), 25-32. https://doi.org/10.31612/2616-4868.1.2024.03


Introduction. Despite the major successes achieved in the treatment of acute coronary syndromes (ACS), acute myocardial infarction (AMI) remains the main cause of death among the working-age population of Ukraine. The means of treatment of interventional cardiology can actually reduce the mortality of patients with ACS, improve the course of the acute period of the disease and ensure less reduction in the functional capabilities of the heart in the future. Among the many pathogenetic mechanisms of vascular inflammation in coronary heart disease and type 2 diabetes, endothelial dysfunction is the determining factor.

The aim of the study. To evaluate the levels of plasminogen activator inhibitor type 1, asymmetric dimethylarginine and endothelial nitric oxide synthase on the 10-14th day in patients depending on the presence or absence of concomitant diabetes type 2 and the type of reperfusion therapy.

Materials and methods. 130 patients with acute myocardial infarction were examined, who were divided into 2 groups: 1 group consisted of patients with acute myocardial infarction with accompanying type 2 diabetes (n=73), 2 group – patients with acute myocardial infarction without type 2 diabetes (n =57). The quantitative content of the plasminogen activator inhibitor type 1 (PAI-1) was determined by the immunoenzymatic method using a commercial test system manufactured by Technoclone PAI-1 ELISA Kit (Austria), endothelial nitric oxide synthase (NOS) – Enzyme-Linked Immunosorbent Assay (ELISA) Kit For Nitric Oxide Synthase Endothelial, asymmetric dimethylarginine (ADMA) – Immunodiagnostik ADMA ELISA Kit (Austria).

Results. Percutaneous coronary intervention (PCI) contributes to a more significant decrease in the content of the marker of endothelial dysfunction – ADMA and an increase in NOS on the 10-14th day of acute myocardial infarction in comparison with standard therapy. During PCI, the level of PAI-1 did not reliably change during treatment due to post-inflammatory and post-traumatic activation of platelets in the vascular wall.

Conclusions. In patients with acute myocardial infarction with type 2 diabetes mellitus, percutaneous coronary intervention contributes to a significant decrease in the content of asymmetric dimethylarginine and an increase in NOS on the 10-14th day of acute myocardial infarction, but was not accompanied by a significant decrease in the level of PAI-1, which in general indicates positive effect of performed myocardial revascularization.



Grasgruber, P., Sebera, M., Hrazdira, E., Hrebickova, S., Cacek, J. (2016). Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries. Food Nutr Res. Sep 27, 60,31694. doi: 10.3402/fnr.v60.31694.

Timmis, A., Townsend, N., Gale, C., Grobbee, R., Maniadakis, N., Flather, M., et al. (2018). Eur Heart J. Feb 14. 39(7). 508-579. doi: 10.1093/eurheartj/ehx628.

Barkoudah, E., Skali, H., Uno, H., Scott, D. Solomon, Marc A. Pfeffer. (2012). Mortality rates in trials of subjects with type 2 diabetes. J. Am. Heart Assoc. Feb, 1(1), 8-15. doi: 10.1161/JAHA.111.000059.

Shimizu, T., Uematsu, M., Yoshizaki, T., Obata, J.E., Nakamura, T., Fujioka, D., et al. (2016). Myocardial Production of Plasminogen Activator Inhibitor-1 is Associated with Coronary Endothelial and Ventricular Dysfunction after Acute Myocardial Infarction. J Atheroscler Thromb. May 2, 23(5), 557-66. doi:10.5551/jat.32300. PMID: 26632165.

Dong, Y., Wu, Y., Choi, H.C., Wang, S. (2016). Diabetic Endothelium Dysfunction, Cardiovascular Complications, and Therapeutics. Diabetes Res., 5349801. doi: 10.1155/2016/5349801.

Stepura, A.O. Kliniko-patohenetychne obhruntuvannia rannoi intensyvnoi hipolipidemichnoi terapii u khvorykh na hostryi infarkt miokarda [dysertatsiia v Interneti]. Kyiv:DU «Natsionalnyi naukovyi tsentr «Instytut kardiolohii im.akad. M.D. Strazheska»; 2019.[tsytovano 2023 zhov. 20] Available from: https://strazhesko.org.ua › 2019/06 › dys_Stepura.

Steg, P.G, James, S.K., Atar, D., Badano, L.P., Blömstrom-Lundqvist, C., Borger M.A., et al. (2012). Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. Oct, 33(20), 2569-619. doi: 10.1093/eurheartj/ehs215.

Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al. (2014). Authors/Task Force members, 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J.,Oct 1,35(37),2541-619. doi: 10.1093/eurheartj/ehu278.

Gaiz, A., Mosawy, S ., Colson N., Singh I. (2017). Thrombotic and cardiovascular risks in type two diabetes; Role of platelet hyperactivity. Biomed Pharmacother, Oct 94, 679-86. doi: 10.1016/j.biopha.2017.07.121.

Navinan, M.R., Mendis, S., Wickramasinghe, S., Kathirgamanathan, A., Fernando, T., Yudhisdran, J. (2019). Inflammation in ST- elevation myocardial infarction: risk factors, patterns of presentation and association with clinical picture and outcome, an observational study conducted at the Institute of Cardiology-National Hospital of Sri Lanka. BMC Cardiovasc Disord., May 14,19(1),111. doi: 10.1186/s12872-019-1104-5.

Fonseca, V.A. (2000). Risk factors for coronary heart disease in diabetes. Ann Intern Med. Jul 18, 133(2), 154-6. doi: 10.7326/0003-4819-133-2-200007180-00015.

Juhan-Vague, I., Alessi, M.C., Vague, P. (1991). Increased plasma plasminogen activator inhibitor 1 levels. A possible link between insulin resistance and atherothrombosis. Diabetologia., Jul,34,457-62. doi: 10.1007/bf00403280.

Song, C., Burgess, S., Eicher, J.D., O'Donnell, C.J., Johnson, A.D. (2017). Causal Effect of Plasminogen Activator Inhibitor Type 1 on Coronary Heart Disease. J Am Heart Assoc., May 26, 6(6). pii: e004918. doi: 10.1161/JAHA.116.004918.

Jung, R.G., Simard, T., Labinaz, A., Ramirez, F.D., Di Santo, P., Motazedian, P., et al. (2018). Role of plasminogen activator inhibitor-1 in coronary pathophysiology. Thromb Res. Apr, 164, 54-62. doi: 10.1016/j.thromres.2018.02.135.

Leibundgut, G., Lee, J.H., Strauss, B.H., Segev, A., Tsimikas, S. (2016). Acute and Long-Term Effect of Percutaneous Coronary Intervention on Serially-Measured Oxidative, Inflammatory, and Coagulation Biomarkers in Patients with Stable Angina. J Thromb Thrombolysis, May , 41(4), 569–80. doi:10.1007/s11239-016-1351-6.

Xuan, C., Tian, Q.W., Li, H., Zhang, B.B., He, G.W., Lun, L.M. (2016). Levels of asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor, and risk of coronary artery disease: A meta-analysis based on 4713 participants. Eur J Prev Cardiol., Mar, 23(5), 502-10. doi: 10.1177/2047487315586094.

Vallance, P. (2001). Importance of asymmetrical dimethylarginine in cardiovascular risk. Lancet., Dec 22-29, 358(9299), 2096-7. doi: 10.1016/S0140-6736(01)07229-4.

Celik, M., Cerrah, S., Arabul, M., Akalin, A. (2014). Relation of asymmetric dimethylarginine levels to macrovascular disease and inflammation markers in type 2 diabetic patients. J Diabetes Res., 139215. doi: 10.1155/2014/139215.

Sen, N., Ozlu, M.F., Akgul, E.O., Kanat, S., Cayci, T., Turak, O., et al. (2011). Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion. Atherosclerosis. 2011 Nov, 219(1), 304-10. doi: 10.1016/j.atherosclerosis.2011.06.021.

Gallo, G., Pierelli, G., Forte, M., Coluccia, R., Volpe, M., Rubattu, S. (2018). Role of oxidative stress in the process of vascular remodeling following coronary revascularization. Int J Cardiol. Oct 1, 268, 27-33. doi: 10.1016/j.ijcard.2018.05.046.

Elgendy, I.Y., Jneid, H. (2018). Microvascular obstruction in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: another frontier to conquer? J Thorac Dis., Mar, 10(3), 1343-1346. doi: 10.21037/jtd.2018.03.58.

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