Prognostic significance of the endothelial dysfunction markers in diagnosis of the atherosclerotic affection degree of coronary vessels in the patients, suffering an acute myocardial infarction with coronary stenting
Objective. To estimate the levels of inhibitor of the plasminogen activator type 1 (ІPA-1) and аsymmetrical dimetilarginin (АDMА) in patients with an acute myocardial infarction (AMI), depending on presence or absence of diabetes mellitus type II (DM2) and character of the coronary arteries (CA) affection, аs well as their prognostic significance concerning degree of the coronary vessels atherosclerotic changes.
Маterials and methods. There were examined 130 patients, 44 (33,85%) - women and 86 (66.15%) - men. All the patients were distributed into two groups: the main - 73 patients with AMI and concurrent DM2, among which there were 43 men and 30 women, average ageing (62.73 ± 1.39) yrs old, and a comparative one - 57 patients with AMI without DM2, including 43 men and 14 women, average ageing (63.98 ± 1.47) yrs old. Control group consisted of 20 practically healthy persons (including 10 men and 10 women, average ageing (60.85 ± 1.37) yrs old). In all the patients a coronarography in standard projections was conducted, using angiograph Siemens Axiom Artis. The ADMA content was established, using immunoassay method, with the help of a commercially available test-system «Immunodiagnostik», manufactured by the ADMA Xpress ELISA Kit (Аustria) company, ІPA-1 - by immunoassay method as well, using a commercially available test-system, manufactured by Technoclone PAI-1 ELISA Kit (Аustria) firm.
Results. In the patients, suffering AMI, not depending on the DM2 presence or absence, the ІPА-1 та АDМА levels are raised, comparing with a control group (р < 0.05). In the patients, suffering hemodynamically significant stenosis (HSS) of CА (70% and more) there were registered the raised levels of ІPA-1 and АDМА while the DM2 presence or absence (р < 0.05). In the patients, suffering an AMI and diffuse affection (DA) of CА, with concurrent DM2 or without it, the levels of ІPA-1 and АDMA were trustworthily higher, than in the patients without DA of CA (р < 0.05).
Conclusion. Comparison of squares under the ROC-curves have shown, that IPA-1 has more diagnostic significance for prognostication of DA of CA in patients with an AMI and concurrent DM2, than АDМА. It is expedient to determine the levels of ІPA-1 and АDМА for prognostication of HSS of CA and diagnosis of the coronary bed DA with the objective to prevent the development of the AMI complications.
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