Adverse cardiovascular event predictors in patients with non-ST-segment elevation myocardial infarction
https://doi.org/10.51922/2616-633X.2025.9.2.2673
Abstract
Non-ST-segment elevation myocardial infarction (NSTEMI) is one of the most common forms of acute coronary syndrome (ACS), characterized by a high risk of cardiovascular events and increased mortality. Despite the achievements of modern medicine in the field of diagnostics and treatment of ACS, predicting adverse outcomes in this category of patients remains an urgent task. The purpose of this article is an overview of modern predictors of adverse cardiovascular events in patients with NSTEMI.
About the Authors
S. I. Kuznetsova
Educational Institution “Belarusian State Medical University”
Belarus
Belarus
Minsk
E. A. Grigorenko
Educational Institution “Belarusian State Medical University”
Belarus
Belarus
Minsk
D. S. Herasimionak
Educational Institution “Belarusian State Medical University”
Belarus
Belarus
Minsk
N. P. Mitkovskaya
Educational Institution “Belarusian State Medical University”
Belarus
Belarus
Minsk
References
1. Word Health Organization. Cardiovascular diseases (CVDs). Geneva: WHO;31 July 2025. Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
2. American College of Cardiology. Cover Story: Acute Coronary Syndromes – New Perspectives on an Old Theme. Washington, DC: ACC, 2023. Available at: https://www.acc.org/Latest-in-Cardiology/Articles/2024/06/01/01/42/Cover-Story-Acute-Coronary-Syndromes-New-Perspectives-New-Data.
3. Hall M., Lindman A.S., Helgadottir H. et al. Why have temporal trends in STEMI and NSTEMI incidence and short-term mortality differed? 35 years of follow-up in the Reykjavik Study. BMJ Open, 2025, vol. 15, e087815. DOI: 10.1136/bmjopen-2024-087815.
4. Gale C.P., Cattle B.A., Woolston A. et al. Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003-2010. Eur Heart J, 2012, vol. 33(5), pp. 630–639. DOI: 10.1093/eurheartj/ehr381.
5. Gouda P., Savu A., Bainey K.R. tt al. Long-term risk of death and recurrent cardiovascular events following acute coronary syndromes. PLoS One, 2021, vol. 16(7), e0254008. DOI: 10.1371/journal.pone.0254008.
6. Byrne R.A., Rossello X., Coughlan J.J. et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J, 2023, vol. 44(38), pp. 3720–3826. DOI: 10.1093/eurheartj/ehad191. Erratum in: Eur Heart J, 2024, Apr 1;45(13):1145. DOI: 10.1093/eurheartj/ehad870. PMID: 37622654.
7. Rao S.V., O’Donoghue M.L., Ruel M. et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients with Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2025, vol. 151(13), e771–e862. DOI: 10.1161/CIR.0000000000001309.
8. Roe M.T., Li S., Thomas L. et al. Long-term outcomes after invasive management for older patients with non-ST-segment elevation myocardial infarction. Circ Cardiovasc Qual Outcomes, 2013, vol. 6(3), pp. 323–332. DOI: 10.1161/CIRCOUTCOMES.113.000120.
9. Granger C.B., Goldberg R.J., Dabbous O., et al. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med, 2003, vol. 163(19), pp. 2345–2353. DOI: 10.1001/archinte.163.19.2345.
10. D’Ascenzo F., Biondi-Zoccai G., Moretti C. et al: TIMI, GRACE and alternative risk scores in Acute Coronary Syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. Contemporary clinical trials, 2012, vol. 33, pp. 507–514.
11. Fox K.A., Fitzgerald G., Puymirat E. et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open, 2014, vol. 4, e004425.
12. Wenzl F.A., Kraler S., Ambler G. et al. Sex-specific evaluation and redevelopment of the GRACE score in non-ST-segment elevation acute coronary syndromes in populations from the UK and Switzerland: a multinational analysis with external cohort validation. Lancet, 2022, vol. 400, pp. 744–756. DOI: 10.1016/S0140-6736(22)01483-0.
13. Antman E.M., Cohen M., Bernink P.J. et al. The TIMI risk score for unstable angina/ non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA, 2000, vol. 284(7), pp. 835–842. DOI: 10.1001/jama.284.7.835.
14. Backus B.E., Six A.J., Kelder J.C. et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol, 2013, vol. 168(3), pp. 2153–2158. DOI: 10.1016/j.ijcard.2013.01.255.
15. Six A.J., Cullen L., Backus B.E. et al. The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol, 2013, vol. 12(3), pp. 121–126. DOI: 10.1097/HPC.0b013e31828b327e.
16. Lincoff A.M., Harrington R.A., Califf R.M. et al. Management of patients with acute coronary syndromes in the United States by platelet glycoprotein IIb/IIIa inhibition. Insights from the platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy (PURSUIT) trial. Circulation, 2000, vol. 102(10), pp. 1093–110 0. DOI: 10.1161/01.cir.102.10.1093.
17. Erlich A.D., Gratsiansky N.A. Independent registry of acute coronary syndromes record. Characteristics of patients and treatment before dischar ge from hospital. Atherothrombosis, 2009, no. 1, pp. 105-119.
18. Loutati R., Perel N., Bruoha S. et al. Troponin level at presentation as a prognostic factor among patients presenting with non-ST-segment elevation myocardial infarction. Clin Cardiol, 2024, vol. 47(1), e24166. DOI: 10.1002/clc.24166.
19. Gimenez M.R., Twerenbold R., Reichlin T. et al. Direct comparison of high-sensitivity-cardiac troponin I vs. T for the early diagnosis of acute myocardial infarction. Eur Heart J, 2014, vol. 35(34), pp. 2303–2311. DOI: 10.1093/eurheartj/ehu188.
20. Haaf P., Reichlin T., Twerenbold R. et al. Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. Eur Heart J, 2014, vol. (6), pp. 365–375. DOI: 10.1093/eurheartj/eht218.
21. Viswanathan K., Kilcullen N., Morre l l C. et al. Heart-type fatty acid-binding protein predicts long-term mortality and re-infarction in consecutive patients with suspected acute coronary syndrome who are troponin-negative. J Am Coll Cardiol, 2 010, vol. 55(23), pp. 2590–2598. DOI: 10.1016/j.jacc.2009.12.062.
22. Hai-Long W., Xiao-Hua P., Jian-Jun Y. The Prognostic Value of Heart-Type Fatty Acid Binding Protein in Patients with Acute Coronary Syndrome. J Coll Physicians Surg Pak, 2018, vol. 28(1), pp. 56–60. DOI: 10.29271/jcpsp.2018.01.56.
23. Thygesen K., Mair J., Mueller C. et al. Recommendations for the use of natriuretic peptides in acute cardiac care: a position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. Eur Heart J, 2012, vol. 33(16), pp. 2001–2006. DOI: 10.1093/eurheartj/ehq509.
24. Kazakova M., Vysotskaya K., Mit kovskaya N. The role of inflammation in the pathogenesis of atherosclerosis. Emergency cardiology and cardiovascular risks, 2022, vol. 6(2), pp. 1707–1713. doi: 10.51922/2616-633X.2022.6.2.1707. (in Russian).
25. Badimon L., Peña E., Arderiu Get al. C-Rea ctive Protein in Atherothrombosis and Angiogenesis. Front Immunol, 2018, vol. 2(9), pp. 430. DOI: 10.3389/fimmu.2018.00430.
26. Sabatine M.S., Morrow D.A., de Lemos J.A. et al. Multimarker approach to risk stratification i n non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide. Circulation, 2002, vol. 105(15), pp. 1760–11763. DOI: 10.1161/01.cir.0000015464.
27. Gager G.M., Biesinger B., Hofer F. et al. Interleukin-6 level is a powe rful predictor of long-term cardiovascular mortality in patients with acute coronary syndrome. Vascul Pharmacol, 2020 Dec. 135, 106806. DOI: 10.1016/j.vph.2020.106806.
28. Li H., Cen K., Sun W., Feng B. Predictive Value of Blood Interleukin-6 Level in Patients with Acute Coronary Syndrome: A Meta-analysis. Immunol Invest, 2021, vol. 50(8), pp. 964–976. DOI: 10.1080/08820139.2020.1795876.
29. Silvain J., Kerneis M., Zeitouni M. tt al. Interleukin-1β and Risk of Premature Death in Patients With Myocardial Infarction. J Am Coll Cardiol, 2020, vol. 76(15), pp. 1763–1773. DOI: 10.1016/j.jacc.2020.08.026.
30. Barbarash O.L., Kashtalap V.V., Veremeev A.V. et al. Clinical and prognostic significance of interleukin-12 in patients with myocardial infarction. Medical Immunology (Russia), 2011, vol. 13(2-3), pp. 219–226. (in Russian) .
31. Cherneva Z.V., Denchev S.V., Gospodinova M.V. et al. Inflammatory cytokines at admission--independent prognostic markers in patients with acute coronary syndrome and hyperglycaemia. Acute Card Care, 2012, vol. 14(1), pp. 1 3–19. DOI: 10.3109/17482941.2011.655292.
32. Lee C.W., Cheng T.M. Lin C.P., Pan J.P. Plasma haptoglobin concentrations are elevated in patients with coronary artery disease. PLoS One, 2013, vol. 8(10), e76817. DOI: 10.1371/journal.pone.0076817. Erratum in: PLoS One. 2014, vol. 9(1). DOI:10.1371/annotation/5ae7dfbe-64c8-40d1-aff2-42ee2fc9408c. Lee, Chin-Wei [corrected to Lee, Ching-Wei].
33. Brilakis E.S., McConnell J.P., Lennon R.J. et al. Association of lipoprotein-associated phospholipase A2 levels with coronary artery disease risk factors, angiographic coronary artery disease, and major adverse events at follow-up. Eur Heart J, 2005, vol. 26(2), pp. 137–144. DOI: 10.1093/eurheartj/ehi010.
34. Wallentin L., Held C., Armstrong P.W. et al. Investigators. Lipoprotein-Associated Phospholipase A2 Activity Is a Marker of Risk But Not a Useful Tar get for Treatment in Patients With Stable Coronary Heart Disease. J Am Heart Assoc, 2016, vol. 5(6), e003407. DOI: 10.1161/JAHA.116.003407.
35. Eitel I., Nowak M., Stehl C. et al. Endothelin-1 release in acute myocardial infarction as a pre dictor of long-term prognosis and no-reflow assessed by contrast-enhanced magnetic resonance imaging. Am Heart J, 2010, vol. 159(5), pp. 882–890. DOI: 10.1016/j.ahj.2010.02.019.
36. Niepolski L., Jęśko-Białek S., Niepolska J., Pendzińska A. Salusins in Atherosclerosis: Dual Roles in Vascular Inflammation and Remodeling. Biomedicines. 2025, vol. 13(8), 1990. DOI: 10.3390/biomedicines13081990.
37. Alieva A.M., Reznik E.V., Teplova N.V. et al. Salusin-α and salusin-β as new bio logical markers in cardiovascular diseases: literature review. Cardiosomatics, 2023, vol. 14(4), pp. 257–268. DOI: 10.17816/CS568593. (in Russian).
38. Liu J., Ren Y.G., Zhang L.H., Tong Y.W., Kang L. Serum salusin-β levels are associated with the presence and severity of coronary artery disease. J Investig Med, 2015, vol. 63(4), pp. 632–635. DOI: 10.1097/JIM.0000000000000184.
39. Arkan A., Atukeren P., Ikitimur B. et al. The importance of circulating levels of salusin-α, salusin-β, and heregulin-β1 in atherosclerotic coronary arterial disease. Clin Biochem, 2021, Jan. 87, pp. 19–25. DOI: 10.1016/j.clinbiochem.2020.10.003.
40. Borodzicz S., Czarzasta K/, Kuch M/, Cudnoch-Jedrzejewska A. Sphingolipids in cardiovascular diseases and metabolic disorders. Lipids Health Dis. 2015, vol. 16(14), pp. 55. DOI: 10.1186/s12944-015-0053-y.
41. Shu H., Peng Y., Hang W. e t al. Emerging Roles of Ceramide in Cardiovascular Diseases. Aging Dis, 2022, vol. 13(1), pp. 232–245. DOI: 10.14336/AD.2021.0710.
42. Knapp M., Lisowska A., Zabielski P., Musiał W., Baranowski M. Sustained decrease in plasma sphingosine-1-phosp hate concentration and its accumulation in blood cells in acute myocardial infarction. Prostaglandins Other Lipid Mediat, 2013, Oct 106, pp. 53–61. DOI: 10.1016/j.prostaglandins.2013.10.001.
43. Alessenko A.V., Zateyshchikov D.A., Lebedev A.T., Kurochkin I.N. Participation of sphingolipids in the pathogenesis of atherosclerosis. Kardiologiia, 2019, vol. 59(8), pp. 77–87. DOI: 10.18087/cardio.2019.8.10270. (in Russian).
44. Alencar J.N., Feres F., Marchi M.F.N. et al. Beyond STEMI-NS TEMI Paradigm: Dante Pazzanese’s Proposal for Occlusion Myocardial Infarction Diagnosis. Arq Bras Cardiol, 2024, vol. 121(5), e20230733. DOI: 10.36660/abc.20230733.
45. Ricci F., Martini C., Scordo D.M. et al. ECG Patterns of Occlusion Myocard ial Infarction: A Narrative Review. Ann Emerg Med, 2025, vol. 85(4), pp. 330–340. DOI: 10.1016/j.annemergmed.2024.11.019.
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For citations:
Kuznetsova S.I., Grigorenko E.A., Herasimionak D.S., Mitkovskaya N.P. Adverse cardiovascular event predictors in patients with non-ST-segment elevation myocardial infarction. Emergency Cardiology and Cardiovascular Risks journal. 2025;9(2):2673-2686. (In Russ.) https://doi.org/10.51922/2616-633X.2025.9.2.2673
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