2017

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2017/№8

Multifactorial Prognostication of Remote Outcomes in Patients With Non-ST Elevation Acute Coronary Syndrome

Lozhkina N. G.1, Khasanova M. H.1, Kuimov A. D.1, Tsygankova O. V.1, Ragino Yu. I.2, Maksimov V. N.2, Voevoda M. I.2
1Novosibirsk State Medical Univercity, Novosibirsk, Russia
2Research Institute of therapy and preventive medicine, Novosibirsk, Russia

Keywords: acute coronary syndrome; high-sensitivity C-reactive protein; genetic markers; multifactorial prognostication

DOI: 10.18087/cardio.2017.8.10014

Aim. Creation of a mathematical nonlinear regression model for prognostication of 1 year outcomes after non-ST elevation acute coronary syndrome (NSTE ACS) for optimization of rehabilitation, secondary prevention, and personalized approach to treatment. Material and methods. We included in this study 135 patients with confirmed NSTE ACS (mean age 59.1±6.1 years, 94 men and 41 women) admitted to hospital No 1 in Novosibirsk during 2010. During hospitalization and 1 year after discharge these patients received standard medical therapy. All patients underwent clinical and instrumental examination which included electrocardiography, echocardiography, Holter ECG monitoring. Program of clinical investigation also included determination of levels of inflammatory cytokines and molecular genetic studies. Effect of each of studied parameters on the probability of unfavorable one year prognosis was assessed by methods of correlation and factor analysis. Results. The constructed mathematical model of multifactor prognostication of 1 year unfavorable or favorable outcomes after NSTE ACS included patient’s age in years, presence of tachycardia at admission, Killip class >II, life-threatening paroxysmal tachyarrhythmias, as well as serum concentration of high-sensitivity C-reactive protein and CT genotype of a polymorphic variant rs1376251 of TAS2R50 gene. Conclusion. The use of the proposed model of multivariate prognostication of 1 year outcomes of NSTE ACS allows to improve the accuracy of events prediction, as it is based on data from Russian patients and takes into account the activity of subclinical inflammation and genotype of the patient. The model is simple to use and allows to personalize secondary prevention, which will facilitate lowering of total cardiovascular risk in these patients.
  1. Marco R., Carlo P.A., Jean-Philippe C. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2015;11:1–59.
  2. Josien Engel, Ineke van der Wulp, Martine de Bruijne, Cordula Wagner. A cross-sectional multicentre study of cardiac risk score use in the management of unstable angina and non-ST-elevation myocardial infarction. BMJ Open 2015;5: e008523. doi:10.1136/bmjopen-2015–008523
  3. Kang J.S., Goodman S.G., Yan R.T. et al. Management and outcomes of non-ST elevation acute coronary syndromes in relation to previous use of antianginal therapies (from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE]). Am J Cardiol 2013;112 (1):51–56.
  4. Ragino Y. I., Kuimov A. D., Polonskaya Y. V. et al. Dynamics of changes of inflammatory and oxidative biomarkers in the blood of patients with acute coronary syndrome. Кardiologiia 2012;2:18–22. Russian (Рагино Ю. И., Куимов А. Д., Полонская Я. В. и др. Динамика изменений воспалительно-окислительных биомаркеров в крови при остром коронарном синдроме. Кардиология 2012;2:18–22).
  5. Scirica B.M., Sabatine M.S., Jarolim P. et al. Assessment of multiple cardiac biomarkers in non-ST-segment elevation acute coronary syndromes: observations from the MERLIN-TIMI 36 trial. Eur Heart J 2011;32 (6):697–705.
  6. Li Y.Q., Liu N., Lu J.H. Outcomes in patients with non-ST-elevation acute coronary syndrome randomly assigned to invasive versus conservative treatment strategies: a meta-analysis. Clinics (Sao Paulo) 2014;69 (6):398–404.
  7. Lozhkina N. G., Maksimov V. N., Ragino Y. I. et al. Problems of outcomes prognosis of acute coronary syndrome. Modern problems of science and education 2013;4. http://www.science-education.ru/110–9952. Russian (Ложкина Н. Г., Максимов В. Н., Рагино Ю. И. и др. Проблемы прогнозирования исходов острого коронарного синдрома. Современные проблемы науки и образования 2013;4. http://www.science-education.ru/110–9952).
  8. Osmolovskaja V. S., Zatejshhikov D. A., Minushkina L. O. et al. Diagnostic value of the index GRACE in patients with acute coronary syndrome in the Russian population. Cardiovascular Therapy and Prevention 2010;6 (1):246–247. Russian (Осмоловская В. С., Затейщиков Д. А., Минушкина Л. О. и др. Диагностическая значимость индекса GRACE у больных, перенесших острый коронарный синдром в Российской популяции. Кардиоваскулярная терапия и профилактика 2010;6 (1):246–247).
  9. Zykov M. V., Barbarash O. L., Zykova D. S. et al. Comparative characteristics of the hospital mortality predicting scales in patients with myocardial infarction. Russian Journal of Cardiology 2012;1:20–27. Russian (Зыков М. В., Барбараш О. Л., Зыкова Д. С. и др. Сравнительная характеристика шкал прогнозирования госпитальной летальности у больных инфарктом миокарда. Росc кардиол журнал 2012;1:20–27).
  10. Samani N.J., Erdmann J., Hall A.S. et al. Genomewide association analysis of coronary artery disease. N Engl J Med 2007;2357:443–453.
  11. Preuss M., König I.R., Thompson J.R. et al. Design of the Coronary ARtery DIsease Genome-Wide Replication And Meta-Analysis (CARDIoGRAM) Study: A Genome-wide association metaanalysis involving more than 22000 cases and 60000 controls. CARDIoGRAM Consortium. Circ Cardiovasc Genet 2010;3 (5):475–483.
  12. Maksimov V. N., Kulikov I. V., Orlov P. S. et al. The relationship check between the nine single nucleotide polymorphisms and myocardial infarction in the Siberian population. Topical issues of internal medicine. Vestnik RAMN 2012;5:24–29. Russian (Максимов В. Н., Куликов И. В., Орлов П. С. и др. Проверка взаимосвязи между девятью однонуклеотидными полиморфизмами и инфарктом миокарда на сибирской популяции. Актуальные вопросы внутренних болезней. Вестник РАМН 2012;5:24–29).
Lozhkina N. G., Khasanova M. H., Kuimov A. D., Tsygankova O. V., Ragino Yu. I., Maksimov V. N., Voevoda M. I. Multifactorial Prognostication of Remote Outcomes in Patients With Non-ST Elevation Acute Coronary Syndrome. Kardiologiia 2017;57(8):28–33.

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