emcardioНеотложная кардиология и кардиоваскулярные рискиEmergency Cardiology and Cardiovascular Risks journal2616-633XБелорусский государственный медицинский университет10.51922/2616-633X.2024.8.2.2300emcardio-10Research ArticleОригинальные научные публикацииOriginal Scientific ResearchДетерминанты повторных ишемических событий в течение 30 дней у пациентов с острым инфарктом миокардаDeterminants of recurrent ischemic events within 30 days in patients with acute myocardial infarctionПронькоТ. П.PronkoT. P.

 Гродно 

Grodno

tanya_pronko@mail.ruСнежицкийВ. А.SnezhitskiyV. A.

 Гродно 

Grodno

ЛяликовС. А.LialikauS. A.

 Гродно 

Grodno

УО «Гродненский государственный медицинский университет»Grodno State Medical University202418062025822300–2308Copyright © Пронько Т.П., Снежицкий В.А., Ляликов С.А., 20252025Пронько Т.П., Снежицкий В.А., Ляликов С.А.Pronko T.P., Snezhitskiy V.A., Lialikau S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://emcardio.bsmu.by/jour/article/view/10

Цель. Определить детерминанты повторных ишемических событий в течение 30 дней у пациентов с острым инфарктом миокарда (ИМ).Методы. В проспективное обсервационное исследование включены 405 пациентов, разделенные на основании конечных точек на 2 группы, группа 1 – 369 человек без событий, группа 2 – 36 пациентов с повторными ишемическими событиями (тромбоз стента, рецидив инфаркта миокарда, периинфарктная стенокардия). Выполнены исследования в 1–2 сутки ИМ: мультиэлектродная агрегометрия, общий анализ крови с тромбоцитарными индексами, иммуноферментное определение растворимого лиганда CD40, sP-селектина, фактора Виллебранда и эндотелина-1, генотипирование CYP2C19, P2RY12, ITGB3, ITGA2, eNOS3 генов.Результаты. При помощи пошагового дискриминантного анализа построено уравнение: Y = –15,9829 + 0,0211 × Х1 + 0,0777 × Х2 + + 1,1012 × Х3 + 0,0183 × Х4++0,1002 × Х5 + 0,0455 × Х6 + 0,1653 × Х7 + + 0,5568 × Х8 + 0,1546 × Х9 + 0,3175 × Х10, где: Х1 – возраст, годы; Х2 – окружность талии, см; Х3 – ФК NYHA; Х4 – скорость оседания эритроцитов, мм/ч; Х5 – количество лейкоцитов в общем анализе крови; Х6 – значение ADP-test (U) агрегатограммы; Х7 – содержание фибриногена (г/л) в плазме крови; Х8 – результаты генотипирования полиморфного маркера G681A (*2) гена CYP2C19, где носительство генотипа GG = 0, носительство генотипа GA = 1, носительство генотипа AA = 2; Х9 – результаты генотипирования полиморфного маркера C807T гена ITGA2, где носительство генотипа СС = 0, носительство генотипа СТ = 1, носительство генотипа ТТ = 2; Х10 – результаты генотипирования полиморфного маркера T786C гена eNOS3, где носительство генотипа ТТ = 0, носительство генотипа ТС = 1, носительство генотипа СС = 2. Если Y > 0 – вероятность развития повторных коронарных событий в течение 30 суток от начала развития ИМ высокая. Если Y ≤ 0 – вероятность развития повторных коронарных событий в течение 30 суток от начала развития ИМ невысокая. Диагностическая чувствительность модели составляет 77,7%, диагностическая специфичность – 80,0%, точность – 77,9%, прогностическая значимость отрицательного результата (благоприятный прогноз) – 97,6%, прогностическая значимость положительного результата (неблагоприятный прогноз) – 25,3%.Заключение. На краткосрочный прогноз оказывают влияние возраст, абдоминальное ожирение, воспаление и недостаточная эффективность клопидогрела, носительство мутантных аллелей генов CYP2C19, ITGA2 и eNOS3, продукты которых влияют на метаболизм клопидогрела и активность тромбоцитов.

Aim. To identify the determinants of recurrent ischemic events within 30 days in patients with acute myocardial infarction (MI).Methods. The prospective observational study included 405 patients, divided into 2 groups based on endpoints. Group 1 included 369 people without events; group 2 included 36 patients with recurrent ischemic events (stent thrombosis, recurrent myocardial infarction, peri-infarction angina). The following studies were performed: multielectrode aggregometry, blood test with platelet indices, enzyme-linked immunosorbent determination of soluble CD40 ligand, sP-selectin, von Willebrand factor and endothelin-1 on days 1–2 of MI, genotyping of CYP2C19, P2RY12, ITGB3, ITGA2, eNOS3 genes.Results. Using step-by-step discriminant analysis, the following equation was constructed: Y = –15,9829 + 0,0211 × X1 + 0,0777 × X2 + 1,1012 × X3 + + 0,0183 × X4++0,1002 × X5 + 0,0455 × Х6 + 0,1653 × Х7 + 0,5568 × Х8 + + 0,1546 × Х9 + 0,3175 × Х10, where: Х1 – age, years; X2 – waist circumference, cm; X3 – NYHA FC; X4 – erythrocyte sedimentation rate in a blood test, mm/h; X5 – the number of leukocytes in a blood test; X6 – ADP-test (U) value of the aggregogram; X7 – fibrinogen level (g/l) in blood plasma; X8 – results of genotyping of the polymorphic marker G681A (*2) of the CYP2C19 gene, where carriage of genotype GG = 0, carriage of genotype GA = 1, carriage of genotype AA = 2; X9 – results of genotyping of the C807T polymorphic marker of the ITGA2 gene, where carriage of genotype CC = 0, carriage of genotype ST = 1, carriage of genotype TT = 2; X10 – results of genotyping of the T786C polymorphic marker of the eNOS3 gene, where carriage of the TT genotype = 0, carriage of the TC genotype = 1, carriage of the CC genotype = 2. If Y > 0, the probability of developing recurrent ischemic events within 30 days from the onset of MI is high. If Y ≤ 0, the probability of developing recurrent ischemic events within 30 days from the onset of MI is low. The diagnostic sensitivity of the model is 77.7%, diagnostic specificity is 80.0%, accuracy is 77.9%, the predictive value of a negative result (favorable prognosis) is 97.6%, the predictive value of a positive result (unfavorable prognosis) is 25.3 %.Conclusions. Short-term prognosis is influenced by age, abdominal obesity, inflammation and insufficient efficacy of clopidogrel, carriage of mutant alleles of the CYP2C19, ITGA2 and eNOS3 genes, the products of which affect the metabolism of clopidogrel and platelet activity.

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The authors declare that there are no conflicts of interest present.