Prognostički značaj biomarkera inflamacije kod bolesnika sa i bez dijabetesa koji su lečeni primarnom perkutanom koronarnom intervencijom zbog akutnog infarkta miokarda sa elevacijom ST segmenta
Sažetak
Apstrakt
Uvod/Cilj. Iako je poznat prognostički značaj inflamatornih biomarkera kao što su C-reaktivni protein (CRP) i fibrinogen, kod bolesnika sa akutnim infarktom miokarda sa elevacijom ST-segmenta (STEMI), postojanje razlike u zavisnosti od prisustva ili odsustva dijabetesa nije poznato. Metode. Istraživanje je sprovedeno u medicinskom centru tercijernog nivoa. Kod bolesnika sa STEMI, lečenih primarnom perkutanom koronarnom intervencijom (pPKI) merene su vrednosti CRP-a i fibrinogena, u toku prvih 48h od prijema. Bolesnici su bili podeljeni u dve grupe: grupu sa dijabetesom i grupu bez dijabetesa. Cilj rada bio je da se utvrdi prognostički značaj maksimalnih vrednosti ta dva biomarkera zapaljenja za nastanak intrahospitalne i šestomesečne smrtnosti u svakoj od grupa. Rezultati. Među 475 bolesnika, 126 (26,5%) je imalo dijabetes, a 349 (73,5%) nije imalo dijabetes. Bolesnici sa dijabetesom su imali značajno veću vrednost medijane CRP-a i fibrinogena u poređenju sa bolesnicima bez dijabetesa [29,6 (10,4–91,8) vs 22,4 (9,79–49,2) mg/L, p = 0,046 i 4,7 (3,6–6,3) g/L vs 4,3 (3,6–5,4) g/L, p = 0,026]. Međutim, korišćenjem Cox regresione multivarijantne analiza smrtnosti modela pokazano je da su kod bolesnika bez dijabetesa CRP i fibrinogen imali značajnu prognostičku vrednost za nastajanje intrahospitalne smrtnosti [hazard ratio – stopa rizika (HR) = 1,013 95% interval poverenja (CI) (1,004–1,022), p = 0.004 i HR = 1,529, 1,023–2,287 95%CI, p = 0,039]. Kada je u pitanju šestomesečna smrtnost, nije pronađena statistički značajna razlika. Ukupno preživljavanje je bilo najniže u četvrtom kvartilu CRP-a u grupi bolesnika bez dijabetesa. Zaključak. Visoke vrednosti CRP-a su nezavisan prediktor intrahospitalne i ukupne šestomesečne smrtnosti kod bolesnika sa STEMI koji nemaju dijabetes lečenih pPKI. Fibrinogen se takođe može koristiti kao prognostički marker za intrahospitalnu smrtnost kod nedijabetičara sa STEMI.
Reference
REFERENCES
Fang L, Moore XL, Dart AM, Wang LM. Systemic inflammatory response following acute myocardial infarction. J Geriatr Cardiol 2015; 12(3): 305–12.
Di Stefano R, Di Bello V, Barsotti MC, Grigoratos C, Armani C, Dell OM, et al. Inflammatory markers and cardiac function in acute coronary syndrome: difference in ST-segment elevation myocardial infarction (STEMI) and in non-STEMI models. Biomed Pharmacother 2009; 63(10): 773–80.
Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Taglieri N, et al. Predictive value of high sensitivity C-reactive protein in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention. Eur Heart J 2008; 29(10): 1241–9.
Ribeiro DR, Ramos AM, Vieira PL, Menti E, Bordin OL, Souza PA, et al. High-sensitivity C-reactive protein as a predictor of cardiovascular events after ST-elevation myocardial infarction. Arq Bras Cardiol 2014; 103(1): 69–75. (English, Portuguese)
Suleiman M, Khatib R, Agmon Y, Mahamid R, Boulos M, Kapeliovich M, et al. Early inflammation and risk of long-term development of heart failure and mortality in survivors of acute myocardial infarction predictive role of C-reactive protein. J Am Coll Cardiol 2006; 47(5): 962–8.
Coppola G, Rizzo M, Abrignani MG, Corrado E, Di Girolamo A, Braschi A, et al. Fibrinogen as a predictor of mortality after acute myocardial infarction: A forty-two-month follow-up study. Ital Heart J 2005; 6(4): 315–22.
Cristal N, Slonim A, Bar-Ilan I, Hart A. Plasma fibrinogen levels and the clinical course of acute myocardial infarction. Angiology 1983; 34(11): 693–8.
Sheikh AS, Yahya S, Sheikh NS, Sheikh AA. C-reactive Protein as a Predictor of Adverse outcome in Patients with Acute Co-ronary Syndrome. Heart Views 2012; 13(1): 7–12.
Lontchi-Yimagou E, Sobngwi E, Matsha TE, Kengne AP. Diabetes mellitus and inflammation. Curr Diab Rep 2013; 13(3): 435–44.
Liuzzo G, Buffon A, Biasucci LM, Gallimore JR, Caligiuri G, Vitelli A, et al. Enhanced inflammatory response to coronary angioplasty in patient with severe unstable angina. Circulation 1998; 98(22): 2370–6.
Saleh N, Svane B, Jensen J, Hansson LO, Nordin M, Tornvall P. Stent implantation, but not pathogen burden, is associated with plasma C-reactive protein and interleukin- 6 levels after percutaneous coronary intervention in patients with stable an-gina pectoris. Am Heart J 2005; 149(5): 876–82.
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the Euro-pean Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients pre-senting with ST-segment elevation. Eur Heart J 2012; 33(20): 2569–619.
Suleiman M, Aronson D, Reisner SA, Kapeliovich MR, Markiewicz W, Levy Y, et al. Admission C-reactive protein levels and 30-day mortality in patients with acute myocardial infarction. Am J Med 2003; 115(9): 695–701.
Nikfardjam M, Mullner M, Schreiber W, Oschatz E, Exner M, Do-manovits H, et al. The association between C-reactive protein on admission and mortality in patients with acute myocardial infarction. J Int Med 2000; 247(3): 341–45.
Ziakas A, Gavrilidis S, Giannoglou G, Souliou E, Gemitzis K, Ka-lampalika D, et al. In-hospital and long-term prognostic value of fibrinogen, CRP, and IL-6 levels in patients with acute myocardial infarction treated with thrombolysis. Angiology 2006; 57(3): 283–93.
Chan D, Ng LL. Biomarkers in acute myocardial infarction. BMC Med 2010; 8: 34.
Zairis MN, Adamopoulou EN, Manousakis SJ, Lyras AG, Bibis GP, Ampartzidou OS, et al. The impact of hs C-reactive protein and other inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndromes. Atherosclerosis 2007; 194(2): 397–402.
O'Loughlin J, Lambert M, Karp I, McGrath J, Gray-Donald K, Barnett TA, et al. Association between cigarette smoking and C-reactive protein in a representative, population-based sample of adolescents. Nicotine Tob Res 2008; 10(3): 525–32.
Lakoski SG, Cushman M, Palmas W, Blumenthal R, D'Agostino RB Jr, Herrington DM. The relationship between blood pressure and C-reactive protein in the Multi-Ethnic Study of Atherosclerosis (MESA). J Am Coll Cardiol 2005; 46(10): 1869–74.
Khera A, McGuire DK, Murphy SA, Stanek HG, Das RS, Vongpatanasin W, et al. Race and Gender Differences in C-Reactive Protein Levels. J Am Coll Cardiol 2005; 46: 464–9.
Kim KH, Kim W, Kang WY, Hwang SH, Cho SC, Kim W, et al. The Impact of Ischemic Time on the Predictive Value of High-Sensitivity C-Reactive Protein in ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutane-ous Coronary Intervention. Korean Circ J 2013; 43(10): 664–73.
Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol J, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA 2006; 295(14): 1681–7.