Common predictors of death in patients with STEMI and NSTEMI during 1st year of postinfarction period

Abstract Aim Evaluation the levels of markers having highest prediction value regarding the risk of death in patients with STEMI and NSTEMI in 1 year after angioplasty. Material and methods The study enrolled 558 patients with STEMI and 553 pts with NSTEMI. From those who dead and survived 4 groups of pts have been selected by equal number 75 and homogenous concerning gender, age, comorbidities, cardiovascular risk factors and time of culprit coronary artery (s) revascularization. 62 markers referring to inflammation, endothelial and hemostasis dysfunction, NETosis, neuroendocrine activity and oxidative stress, cell injury and cardiovascular remodeling have been determined at admission (before coronary angioplasty) and at 24th hour after. Prediction power of markers regarding death risk was estimated by Odd’s ratio. Results Mortality rate was 17,03% (95 pts) in STEMI, and 14,8% (82 pts) in NSTEMI. In concern to Odd’s ratio having highest and similar power of death prediction should be emphasized following 9 markers determined at admission: IL-1β, selectin-E, endocan, von Willebrand/ADAMTS13 ratio, platelets microvesicles (CD62P), neutrophil elastase, myeloperoxidase, Ang 1-7/Ang II ratio and GDF-15. The Odd’s ratio of these markers was in a range of 2.26-2.97 (CI p<0,001). Remarkable, that in dead pts only have been found circulating activator autoantibodies against receptor ETA of ET-1 in 21 pts of STEMI (22.1%) and 16 pts of NSTEMI (19.5%). Noteworthy, in the top of reperfusion outrage on myocardium (first 24 hours) the increment of ischemia modified albumin (IMA) and H-FABP was significantly higher in dead vs survivors. More than that, the increasing ratio of these markers was higher in NSTEMI vs STEMI: 88.5 and 104.8% vs 65.5 and 85.2%, what in principle confirms the Heusch’s hypothesis viewing ischemic precondition influence on myocardial damage inherent to reperfusion impact. Conclusion Our study underlined at admission 9 circulating markers demonstrating a highest and similar Odd’s ratio of death risk in pts with either STEMI of NSTEMI which conceptually could be linked to key mechanisms of coronary microcirculatory dysfunction. Likewise, the increment of IMA and H-FABP from admission to 24 hours may reliably predict risk of death, and its higher level in NSTEMI indicates a more considerable contribution of reperfusion impact on myocardial damage in comparison with STEMI.