cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2018.12.10205cardio-369Research ArticleОСТРЫЙ КОРОНАРНЫЙ СИНДРОМACUTE CORONARY SYNDROMEНезависимые предикторы сердечно-сосудистых осложнений у пациентов с острым коронарным синдромом после чрескожного коронарного вмешательства на госпитальном этапеIndependent Predictors of Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome After Percutaneous Coronary Intervention During HospitalizationМансуроваД. А.MansurovaJ. A.

Mansurova Jamilya A. - doctoral student PhD, MD

mansurova_dzhami@mail.ruКаражановаЛ. К.KarazhanovaL. K.Республиканское государственное предприятие на праве хозяйственного ведения (РГП на ПХВ) «Государственный медицинский университет г. Семей» Минздрава Республики КазахстанРоссияSemey State Medical UniversityRussian Federation20182512201858122229Copyright © Kardiomag, 20182018KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/369Цель исследования

Цель исследования. Выявление независимых клинических и лабораторных предикторов сердечно­сосудистых осложнений (ССО) у пациентов с острым коронарным синдромом (ОКС) после чрескожного коронарного вмешательства (ЧКВ) со стентированием на раннем госпитальном этапе.

Материалы и методы

Материалы и методы. В проспективное одноцентровое исследование включены 130 пациентов с ОКС, которым было проведено ЧКВ со стентированием. Все пациенты до и после ЧКВ получали двухкомпонентную антитромбоцитарную терапию ацетилсалициловой кислотой и клопидогрелом. Через 12–48 ч после ЧКВ была определена остаточная реактивность тромбоцитов (ОРТ) агрегометром AggRAМ. Одновременно 57 пациентам было проведено генотипирование полиморфизма гена CYP2C19 по аллелю*2. За конечные точки были приняты случаи ССО: внезапная смерть, тромбоз стента, артериальный тромбоз другой локализации, повторная стенокардия, нарушение ритма, обусловившие необходимость назначения терапии. Наблюдение проводилось в течение госпитального периода, средняя продолжительность составила 9,7±3,2 дня.

Результаты

Результаты. У 32 пациентов после ЧКВ наблюдались повторные ССО, факторами риска развития которых, по данным однофакторного регрессионного анализа, явились ОРТ, индуцированная 10 мкг / мл аденозин­5′­дифосфатом – АДФ (р<0,001), площадь под кривой агрегации – AUC (р<0,001), уровень креатинина (р<0,001), гемоглобина (р<0,001) и глюкозы крови (р=0,026), возраст (р=0,01), железодефицитная анемия (р=0,01), фракция выброса левого желудочка (р=0,004), количество стентов (р=0,015). В результате многофакторного регрессионного анализа были установлены независимые предикторы развития ССО: уровень ОРТ, индуцированной АДФ, ≥76 % (р=0,003), креатинина ≥189 мкмоль / л (р=0,003) и гемоглобина ≤114 г / л (р=0,004). Выявлено статистически значимое влияние гомозиготного носительства CYP2C19*2 (G681A) (А / А) на развитие тромбоза стента (р=0,028).

Заключение

Заключение. ОРТ, индуцированная АДФ, уровень креатинина и гемоглобина явились независимыми предикторами госпитальных ССО у пациентов с ОКС после реваскуляризации миокарда со стентированием.

Purpose

Purpose: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period.

Materials and methods

Materials and methods. We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12–48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end­points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy.

Results

Results. Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F­induced RPR (р<0.001), levels of creatinine (р<0.001), hemoglobin (р<0.001), and glucose (р=0.026), age (р=0.01), iron­deficiency anemia (р=0.01), left ventricular ejection fraction (р=0.004), number of stents (р=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP­induced RPR >76 % (р=0.003), levels of creatinine >189 µmol / L (р=0.003), and hemoglobin <114 g / L (р=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (А / А) on development of stent thrombosis was also detected (р=0.028).

Conclusion

Conclusion. ADP­induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.

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The authors declare that there are no conflicts of interest present.