[Predicting the development of adverse events in patients with acute coronary syndrome including genetics in the long-term follow-up].

Aim To study a relationship of several factors (clinical and genetical markers) with unfavorable outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in long-term follow-up.Material and methods This full-design, prospective study included 415 patients with NSTE-ACS. 266 patients were evaluated for the presence of multifocal atherosclerosis (MFA). Typing of polymorphic variants rs1041981 LTA, rs1800629 TNF, rs4986790, and rs498679 TLR4, and also rs3024491 and rs1800872 IL10 was performed. Follow-up period lasted for 67±4 months. By the end of this period, information about clinical outcomes for 396 patients became available.Results During the entire follow-up period, unfavorable outcomes were observed in 239 (57.5 %) patients with NSTE-ACS. The following clinical signs were associated with unfavorable outcomes: history of myocardial infarction, age >56 years, left ventricular ejection fraction (LV EF) ≤50 % and GRACE score ≥100, significant stenosis of brachiocephalic arteries, MFA, carriage of genotype А / А rs1041981 LTA (OR, 6.1; р=0.02) and allele А (OR, 1.9; р=0.01). According to results of a multifactorial analysis, the most significant predictors included LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.Conclusion Stratification of patients with NSTE-ACS into groups of high or low risk for having an unfavorable outcome within the next 6 years is possible using the prognostic model developed and presented in this study. The model includes the following signs: LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.

[Assessment of Outcomes and Treatment Tactics in Patients With Non-ST-Elevation Acute Coronary Syndrome: Data of Five-Year Follow-up].

PURPOSE: to study the role of clinical factors and treatment tactics in the development of adverse outcomes in patients with non-STelevation acute coronary syndrome (NSTEACS) for five years follow up. MATERIALS AND METHODS: The study included 415 patients with NSTEACS observed for 60±4 months from the date of discharge. Adverse events (AE) were unstable angina (UA), myocardial infarction (MI), ischemic stroke or patient's death. The favorable 5-year outcome was identified in 200, adverse outcome - in 178 patients. Statistical processing was performed using STATISTICA 8.0 software package and MedCalc 11.0. RESULTS: Total mortality for 60 months was 16.1% (n=61). Highest mortality, maximal number of hospitalizations due to MI (41.1%) and UA (49.6%) were observed during first 12 months. Greatest impact on the development of AE produced: history of MI, higher GRACE score, age >54 years (p=0.0021), stenosis in brachiocephalic arteries, ischemic changes on admission ECG and reduced left ventricular ejection fraction (LVEF) ≤ 52% (p=0.0001). Five-year survival rate was influenced by coronary angiography (p=0.0001) and percutaneous coronary intervention (PCI) during index hospitalization (p=0.0039). DISCUSSION: Mortality and frequency of AE in this register were close to generally reported. The observed adverse impact on the long-term outcome of such risk factors such as age over 60 years, history of MI, ischemic ECG changes at admission, decreased LVEF corresponded to literature data. Our study proved the need for coronary imaging in patients with NSTEACS to determine treatment strategy in in hospital period as these factors affected the 5-year survival. CONCLUSION: During five-year follow-up AE occurred in 47.1% of patients with NSTEACS. Maximal number of patients with AE was registered during the first (24.7%) and fifth (13.8%) year of observation. The development of AE was associated with older age, history of MI and coronary artery bypass grafting, ischemic ECG changes, decreased LVEF, higher GRACE score, and brachiocephalic artery stenosis. Carrying out diagnostic coronary angiography and PCI with stenting during hospitalization in patients with NSTEACS was associated with favorable 5-year outcome.

[Prognostic factors in patients with non-ST-segment elevation acute coronary syndrome concurrent with type 2 diabetes mellitus (according to the results of the registry)]. / Faktory prognoza u patsientov s ostrym koronarnym sindromom bez pod''ema segmenta ST v sochetanii s sakharnym diabetom 2-go tipa (po rezul'tatam registra).

AIM: To investigate factors that influence annual prognosis in patients with non-ST-segment elevation acute coronary syndrome ((NSTEACS) concurrent with type 2 diabetes mellitus (DM2). SUBJECTS AND METHODS: The registry of patients with NSTEACS (non-ST-segment elevation myocardial infarction (NSTEMI), unstable angina) included 415 patients, of them 335 had no carbohydrate metabolic disorders, 80 had DM2. The follow-up period, during which the prognosis was evaluated in the patients, was one year after hospital discharge following the index NSTEACS event. Lipidogram readings and the serum levels of endothelin-1 (ET-1), sP-selectin, sE-selectin, and sPECAM were determined on day 10 after admission to hospital. All the patients underwent coronary angiography (CA), Doppler ultrasound of peripheral arteries during their hospital stay. RESULTS: The patients with DM2 versus those without diabetes proved to be significantly older and to have a higher body mass index; among them there were more women, they were noted to have more frequently hypertension and less frequently smoked. The presence of DM2 was associated with significantly increased intima-media thickness and higher GRACE scores (p=0.013) as compared to those in the patients with normal carbohydrate metabolism. There were significant differences in high-density lipoprotein levels that were lower, as well as in triglyceride levels and atherogenic index, which were higher in patients with DM2 than in those without this condition. In addition, there were significant differences in ET-1, sP-selectin, sE-selectin, and sPECAM levels that were significantly higher in the DM2 group. Moreover, the levels of ET-1 and sPECAM were above normal in both the DM and non-DM2 groups. Assessment of poor outcomes at one year of the observation established that cardiovascular mortality rates were significantly higher and coronary angiography was performed much less frequently in the DM2 group. The most significant prognostic factors associated with a poor prognosis were as follows: multifocal atherosclerosis, reduced left ventricular ejection fraction (LVEF) less than 51%, and increased ET-1 levels more than 0.87 fmol/ml. CONCLUSION: The register-based study has shown that the presence of DM2 statistically significantly increases cardiovascular mortality rates during a year after the index ACS event; the patients of this category are less commonly referred for CA for the estimation of the degree of coronary bed lesion. The most important factors of recurrent cardiovascular events in patients with DM2 within a year after prior ACS are multifocal atherosclerosis, reduced myocardial contractility (LVEF less than 51%), and increased vasospastic endothelial function (an increase in ET-1 levels more than 0.87 fmol/ml).

[Influence of Endothelial Dysfunction on Prognosis of Patients With Non ST-Segment Elevation Acute Coronary Syndrome].

We studied relationship between markers of endothelial dysfunction and multifocal atherosclerosis and adverse coronary events in 82 patients with non-ST segment elevation acute coronary syndrome (NSTEACS). Eighteen patients (21.9%) had adverse events during one year of observation. Patients with adverse coronary events had impaired vasodilatory, vasoconstrictive, and adhesive endothelial function. Predictors of unfavorable prognosis in NSTEACS were signs of impaired endothelium-dependent vasodilation during test with reactive hyperemia, high soluble platelet selectin and endothelin-1 levels on day 10 of the disease. Endothelin-1 and soluble platelet-endothelial cell adhesion molecule-1 had greatest predictive power relative to development of non-fatal myocardial infarction.

[THE RELATIONSHIP BETWEEN POLYMORPHISMS OF G-1082A AND C-592A LOCI OF THE IL10 GENE AND MULTIFOCAL ATHEROSCLEROSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT SEGMENT ST ELEVATION].

AIM: To study the relationship between polymorphous G-1082A (rs3024491) and C-592A (rs1800872) variants of the IL10 gene and multifocal atherosclerosis (MFA) in patients with acute coronary syndrome (ACS) without segment ST elevation. MATERIALS AND METHODS: Genotypes of polymorphous G-1082A (rs3024491) and C-592A (rs1800872) variants of the IL10 gene were determined in 178 patients. Interleukin-10 (IL-10) level was measured in 93 of them using solid-phase immunoenzymatic assay. All patients underwent visualization of coronary and peripheral arteries. RESULTS: C-592A (rs1800872) polymorphism ofthe IL10 gene tended to be associated with type 2 diabetes mellitus in the carriers of the CC (gg) genotype and with elevated concentration of high density lipoproteins and reduced intima-media thickness in the carriers of the AA (tt) genotype. The frequency of MFA in the carriers of different genotypes of rs1800872 polymorphism was practically identical while the CA(gt) genotype was associated with more severe manifestations of atherosclerosis and AA(tt) genotype with lower frequency of peripheral artery stenosis. Patients with AA(tt) genotype of rs1800872 polymorphism had higher IL-10 levels. No relationship between rs3024491 polymorphism of IL10 gene, blood IL-10 level, clinical risk factors, and MFA was documented. CONCLUSION: CC (gg) genotype of C-592A (rs1800872) polymorphism of the IL10 gene in patients with acute coronary syndrome (ACS) without segment ST elevation was associated with type 2 diabetes mellitus while the AA(tt) genotype of the same polymorphism with elevated concentration of high density lipoproteins, reduced intima-media thickness, low frequency of peripheral artery stenosis, and increased IL-10 production. CA (gt) genotype of rs1800872 polymorphism of the IL10 gene was associated with MFA.

[A poor outcome prediction scale in ST-segment elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention].

AIM: To make a prediction scale using a set of clinical and laboratory prognostic variables for patients with ST-segment elevation myocardial infarction (STEMI) on their electrocardiograms (ECG) who have undergone percutaneous coronary intervention. SUBJECTS AND METHODS: The study enrolled 154 STEMI patients who had undergone percutaneous coronary angioplasty with stenting of the artery supplying blood to the area of an ischemia. Enzyme immunoassay was used to determine the levels of cytokines and selectins on days 1 and 10. RESULTS: During a year, the authors identified the following independent risk factors of a poor outcome (PO): symptoms of Killip Class III-IV heart failure; a history of smoking; rhythm and conduction disturbances on day 1 of the disease; tumor necrosis factor-alpha levels determined on day 1 of the disease; IL-1alpha and sP-selectin levels measured on day 10. In the made prediction scale, a score was assigned to each independent prognostic variable to estimate the risk of PO. The borderline values of summing the scores, which divided the patients into groups at low, moderate, and high risk for PO, were determined for the practical application of the scale, by using the receiver operating characteristic curve (ROC) analysis. The performance of the model was tested using an independent sample of STEMI patients (n = 50). The probability that the classification of the model was correct amounted to 89.6% (p < 0.0001). CONCLUSION: The made prediction scale allows the patients with STEMI to be allocated to groups at low, moderate, high risks for PO during a year. Evaluation of the prognostic efficiency of the new scale versus the known scales PAMI, CADILLAC, and TIMI ST elevation, by plotting the ROC curve and estimating the area under the latter, demonstrated the high predictive ability of the new scale.

[The role of multifocal atherosclerosis in realization of new cardiovascular complications during one year after non ST-elevation acute coronary syndrome].

STUDY AIM: to assess prognostic value of multifocal atherosclerosis (MFA) relative to risk of new cardiovascular catastrophes in patients with non ST elevation acute coronary syndrome (NSTEACS) during one year follow-up. MATERIAL AND METHODS: atients with NSTEACS (n=266) subjected to coronary angiography and color duplex scanning of peripheral arteries (PA) were included in this study. Presence of "end points" (cardiovascular death, stroke, myocardial infarction, unstable angina, decompensation of heart failure) was assessed after one year of follow-up. RESULTS: aximal GRACE score was revealed in patients with MFA (combined involvement of coronary arteries [CA] and peripheral arteries [PA]). Compared with patients without involvement of CA or PA unfavorable outcomes were 2 times more frequent in the presence of lesions only in CA, 3 times more frequent in the presence of combination of lesions in CA and PA stenoses <50%, 4 times more frequent in the presence of lesions in CA and PA stenosis >50%. Percutaneous coronary intervention at the hospital stage led to 3.3-fold improvement of long term prognosis in patients with single vessel CA involvement and absence of stenoses in PA, and to 1.8 fold improvement - in patients with multivessel CA involvement and PA stenoses >50%. CONCLUSION: resence of even nonsignificant PA stenoses in patients with NSTEACS predetermined high rate of unfavorable events during one year follow-up.

[Clinical and prognostic significance of multifocal atherosclerosis in patients with acute coronary syndromes without ST-segment elevation].

Aim of the study was to determine incidence of multifocal atherosclerosis (MFA), to assess its clinical and prognostic significance in the hospital phase in patients with non-ST elevation acute coronary syndrome (NSTEACS). We studied data from 225 patients with duration of NSTEACS 48 hours or less, who along with usual examination were subjected to coronary angiography and color duplex scanning of extracranial arteries and arteries of lower extremities. As lesions we considered any stenosis irrespective of intima media thickness. MFA was detected in 43.6% of cases. Patients with MFA were older, they more often had history of myocardial infarction, had lower creatinine clearance, and left ventricular ejection fraction. Presence of artery stenoses in 3 vascular regions was associated with multivessel coronary artery disease. Inhospital "endpoints" (myocardial infarction, stroke, death) occurred more frequently in patients with MFA. Patients with lesions in 2 and 3 vascular beds were characterized by maximal Grace score, while those without coronary and peripheral artery involvement- by minimal Grace score. The presence of MFA in patients with NSTEACS was associated with unfavourable course of the disease. Thus ptatients with MFA were characterized by high average rating on Grace scale; involvement of three vascular beds was associated with high mortality.

[Predictors of stent thrombosis in patients with ST-elevation acute coronary syndrome subjected to primary coronary artery intervention].

Basing on complex evaluation of clinical, angiographic, and laboratory data we revealed predictors of stent thrombosis in patients with ST-elevation acute coronary syndrome (ACS) subjected to percutaneous coronary interventions (PCI). Among studied sample of patients (n=124) we distinguished a group of patients with proven stent thrombosis at various stages of follow-up (n=22, group 1) and a group of patients with favorable outcome (n=102, group 2). Unifactorial analysis revealed unfavorable prognostic influence (p=0.025) of hemodynamically significant stenosis of proximal segment of anterior distending artery, disturbances of rhythm and conduction (p=0.0002), as well as degree of heart failure (HF) according to Killip on day 1 of development of symptoms of ACS, and also of high selectin P level on day 10 (p=0.031). With the aim of assessment of prognostic significance of revealed factors we conducted stepwise discriminant analysis according to results of which most significant parameter affecting development of stent thrombosis in patients with ST-elevation ACS appeared to be high Killip class of HF (p<0.0003), to a lesser degree - elevated level of sP-selectin on day 10 of observation (p=0.005). Parameter for which prognostic significance was not revealed as a result of multifactorial analysis was lesion in proximal segment of anterior descending artery (p=0.496). Probability of correct classification of the model was 88.7% at p<0.0001.

[Predictors of coronary adverse events in patients with acute coronary syndrome with ST segment elevation treated with percutaneous coronary interventions with stenting].

OBJECTIVE: The aim of this 12 months observational study was to investigate risk factors of major adverse coronary events, such as death or Q wave myocardial infarction due to stent thrombosis or in stent restenosis. MATERIAL AND METHODS: One hundred fifty four patients with ST segment elevation acute coronary syndrome were treated with percutaneous coronary intervention (PCI) and with implantation of metal stent. TIMI and CADILLAC scores were used for evaluation of initial risk. Blood levels of cytokines and sP selectin were measured on day 1 before PCI and on day 10 of hospitalization. RESULTS: We proved that CADILLAC score was applicable for evaluation of prognosis in patients with acute coronary syndrome and ST segment elevation treated with coronary stenting. High levels of tumor necrosis factor during first 24 hours of acute coronary syndrome and interleikin 8 on day 10 after PCI were found to be risk factors of major adverse coronary events during subsequent 12 months. High sP selectin level on day 10 predicted stent thrombosis during long term follow up.