| Popis: |
Objective. to develop independent predictors for predicting long-term myocardial infarction (MI) in patients (pts) with unstable angina (UA) after coronary artery stenting (PCI) based on the results of a seven-year follow-up. Materials and Methods. The study involved 165 pts with UA and coronary artery stenting (PCI). PCI was performed in 3.2±1.6 days after admission to the in-patient department. Drug-coated stents (Xience V and Biomatrix) were used, the average number of stents was 2.1±0.8 per person, the average length of the stented area was 43.12±25.6 mm, and the average diameter of the implanted stents was 3.12±0.5 mm. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; coagulation hemostasis was assessed; and a thrombin generation test was performed. The aggregatogram was performed on the analyzer Multiplate (ASPI-test, ADP-test). The patients underwent echocardiography, coronary angiography. Double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg was prescribed for 12 months. The follow-up period was 7±1.6 years. Results. Repeated UA developed in 91 (55.2%) pts during a 7-year follow-up period, myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent predictors of MI risk included: baseline D-dimer level ≥796 ng/ml AUC 0.766 (RR 5.272; 95% CI 2,125-13,082), endogenous thrombin potential ≥2294.5 nM*min AUC 0.912 (RR 4,769; 95% CI 2,457-10,546), N-terminal fragment of brain natriuretic peptide (NTproBNP) ≥816 pg/ml AUC 0.794 (RR 1,935; 95% CI 1,218-3.075), homocysteine level ≥16 µmol/l AUC 0.707 (RR 1.971; 95% CI 1.140-3.406), highly sensitive C-reactive protein ≥6.4 g/l AUC 0.790 (RR 1.333; 95% CI 1.081-1.644), number of affected arteries≥ 3 AUC 0.714 (RR 2.129; 95% CI 1.237-2.664). The developed model for predicting myocardial infarction included the initial level of endogenous thrombin potential≥2294.5 nM * min, D-dimers ≥796 ng / ml, and the number of affected coronary arteries≥ 3. For the developed model, the AUC was 0.964, which corresponds to the excellent quality of the model. Conclusion. The prognosis of myocardial infarction in patients with unstable angina and stenting of the coronary arteries receiving the standard antiplatelet therapy involves laboratory criteria that reflect the activation of the hemostatic system and the residual thrombogenic risk. |
