Predictors of 1-year follow-up period MACE in patients with NSTEMI

Abstract Background Identifying viable predictors of MACE in NSTEMI continues to pose a challenge in the field of cardiology. Unraveling these factors will elucidate crucial mechanisms underlying adverse post-infarction outcomes and identify key strategies for optimizing treatment. Aim Evaluation by using the multi-marker panel the biomarkers having a high predictive value regarding the risk of MACE developing in patients with NSTEMI. Methods The study embraced 550 patients with NSTEMI treated by angioplasty. A panel of 67 biomarkers was quantitatively determined by ELISA, immune assay and flow cytometry on admission in the blood linked to the most important mechanisms conceptually involved in post-infarction evolution (inflammation, endothelial dysfunction, hemostasis disorders, oxidative stress, NETosis, Ang 1-7/Ang II axis etc.) The rate of MACE (cardiac death, stroke, myocardial reinfarction) was estimated in a follow-up period of 18 months. In order to underline the overt predictors, the hazard ratio CI (95%) was assayed. 60 healthy persona formed control series. Results Upon admission, the circulating levels of 62 out of 67 biomarkers in patients with NSTEMI significantly deviated from control values. The MACE rate during 1-st year after revascularization was 28% (154 pts). According to hazard ratio (HR) the maximal predictive power regarding MACE risk of 1-year follow-up period was unraveled for 3 markers: endothelial microparticles (EMs), platelet-derived microvesicles (PMVs) and von Willebrand/ADAMTS13 ratio. For EMs – HR 2.21 CI (1.19-3.84; p<0.01); for PMVs - HR 2.56 CI (1.43-3.96; p<0.01); for von Willebrand/ADAMTS13 ratio - HR 2.94 CI (1.77-4.73; p<0.01). EMs-CD62E exceeded control level by 77,6% (325.6±101.5 vs 183.2±67.7 Ms/µL); PMVs-CD62P by 129% (378.6±87.4 vs 165.5±59.6 MVs/µL) and von Willebrand/ADAMTS13 ratio by 88% (2.52±1.88 vs 1.34±1.11). These predictors have not been adjusted to age, gender and cardiovascular risk factors. Conclusion Considering the pathophysiological significance of the highlighted predictors of MACE (EMs, PMPs and the von Willebrand/ADAMTS13 ratio) endothelial dysfunction and an activated prothrombotic state emerge as pivotal mechanism in the adverse progression of NSTEMI. THUS, these predictors should indicate a focus on corrective therspy targets.