MACE prediction in patients with STEMI and NSTEMI: from classic to novel markers in the estimation of coronary microcirculation disorder

Abstract

Aim. Evaluation of classic and novel markers of coronary microcirculatory disorder (CMD) which have a predictive value on the risk of major cardiovascular event (MACE) in patients with STEMI and NSTEMI. Material and methods. The research included the retrospective analysis of a prospective observational study carried out on 600 patients, of which have been formed equal 4 groups of 80 patients (STEMI+MACE; STEMI-MACE; NSTEMI+MACE; NSTEMI-MACE) in which the collected blood on the 5-th day after angioplasty, the circulating level of 16 markers referring to CMD in the field of estimating endothelial dysfunction and hemostasis was determined: 8 classic markers (hsCRP, IL-6, TNF-α, IL-10, myeloperoxidase, NO , angiopoietin 2, fibrin monomers) and 8 new markers (neopteirn, endocan, syndecan 1, L-Arginine/ADMA, Ang 1-7/Ang II, endothelial microparticles, platelet microparticles, von Willebrand/ADAMTS13). In order to assess the prediction of MACE (cardiac death, re-infarction, stroke) at 1-st year, the relative risk of markers that had significant differences in patients with MACE versus without MACE in both groups (STEMI and NSTEMI) was assessed. The control group consisted of 40 apparently healthy people. Results. The MACE rate in STEMI and NSTEMI patients at 1 year was similar, 29% and 28%, respectively. All markers of endothelial dysfunction explored had significant deviations from control. Of these, however, only 4 markers had significant different values in patients (STEMI and NSTEMI) with MACE vs without MACE: neopterin, endocan, L-Arginine/ADMA and Ang 1-7/Ang II. Remarkably, all 3 markers of hemostasis explored had circulating levels in patients who developed MACE significantly higher than patients without MACE, which significantly exceeded the control marker. The assessment of the relative risk value has allowed the delineation of markers regarding the prediction of MACE such as: von Willebrand/ADAMTS13, platelet microparticles, fibrin monomers, endocan, neopterin, Ang 1-7/ Ang II, L-Arginine/ADAMTS13. Conclusions. 1. Endothelial dysfunction and compromised hemostasis are pathophysiological pillars of CMD which influences the MACE risk, and thus new markers such as von Willebrand/ADAMTS13 ratio, platelet microparticles, endocan, the ratio Ang 1-7/Ang II and L/Arginine/ ADMAs have notable predictive value on MACE.2. Since CMD may be a key mechanism of cardiac ischemia in chronic non-obstructive coronary artery disease (<50%) its evaluation, including through the identified predictors, has a conclusive diagnostic and prognostic relevance.