PROGNOSTIC BLOCK-SCHEME OF CLINICAL OUTCOME OF ACUTE CORONARY SYNDROME INTO Q-MYOCARDIAL INFARCTION. PART I

Aim. T o develop a block-scheme for short-term personified prognosis of clinical outcome of acute coronary syndrome (ACS) into Q-myocardial infarction at prehospital stage.

Material and methods. Totally 68 patients included with the diagnosis of ACS. As prognostic factors we used the most informative intervals of concentrations of the markers for subclinical nonspecific inflammation, endothelial dysfunction, cardiospecific changes in the immune system and serum cardiomarkers. For testing of those mentioned we used the hard-phased immunoenzyme assay. The relative risk (RR) with confidence intervals (CI) were calculated, as the absolute risk (AR), diagnostic efficacy (DE) of the methods used related to clinical outcomes of ACS into Q0MI related to the risk factor studied (intervals of markers concentrations). Statistic processing was done with software Statistica 6.0 and Biostat 4.03.

Results. Depending on the complex analysis of the results we formulated a blockscheme of short-term personified prognosis of clinical outcome of ACS into Q-MI. The scheme included the most informative intervals of concentrations. Personified shortterm prognosis of clinical outcome of ACS into Q-MI and prehospital stage was related to the concentrations of cardiomarkers: TP-I from 2,2 до 2,7 ng/ml, BNP-32 from 1079 to1270 pg/ml; inflammtion markers : CRP from 20 to 25 mg/L, IL-1β from 0,54 to 1,54 pg/ml and TNF-α from 1,1 to 1,6 pg/ml; endothelial dysfunction markers: NO from 7 to 11 mcM/L, ET from 5 to 6 fM/ml, ММР-9 from 270 to 370 ng/ml and TIMP-1 from 140 to 150 ng/ml; immunomarkers: N P from 20 to 28 nM/ml, AB to KL from 15 to 20 U/ml and in 75% cases there are AB to cardiomyocytes. Patients having these parameters at their admission are in the higher risk group of clinical outcome ACS into Q-MI.

Conclusion. In the cases when at admission the parameters of inflammation, endothelial dysfunction, serum cardiomarkers and immunomakrers match with the intervals of concentrations mentioned in the block-scheme, these patients are in the group of higher risk of outcome ACS into Q-MI. This lets even at earlier stage of hospitalization to perform the treatment procedures in accordance with the standards of treatment of the patients with occlusing lesions of coronary arteries, that lead to a large focus of MI.

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