Značaj markera endotelne disfunkcije, oksidativnog stresa i inflamacije u dvogodišnjoj prognozi kod bolesnika sa akutnim infarktom miokarda

Abstract

In the etiopathogenesis of acute myocardial infarction, in addition to ischemia and necrosis, an important role play inflammation, endo-thelial dysfunction, and oxidative stress. A single marker that would reflect all the processes involved in the formation of atherosclerotic plaque, its destabilization and the occurrence of acute coronary events resulting in myocardial dysfunction is not found. For these rea-sons, it is necessary to implement multimarker testing, which would give us, not only an insight into the activation of specific mechanisms involved in this situation but to determine the prognosis of the dise-ase. The aim of the research was to determine the value of certain markers of endothelial dysfunction (endothelin-1, a urinary albumin-creatinine ratio, nitric oxide degradation priducts), oxidative stress markers (superoxide dismutase, catalase, glutathione peroxi-dase, thiol groups, malondialdehyde and advanced oxidation protein products) and markers of inflammation on the third day after an acute coronary event, and to evaluate the importance of these markers as predictors of two-year prognosis in patients with acute coronary syndrome. The results show that markers of endothelial dysfunction, oxida-tive stress, and inflammation are raised on the third day after acute myocardial infarction and that their determination can significantly contribute to intrahospital and two-year prognosis. The concentrations of endothelin-1 above the 75th percentile were associated with poor intrahospital and two-year prognosis while the increased urinary albumin-creatinine ratio was associated with the risk of a two-year mortality and reinfarction due to in-stent thrombosis. Reduced levels of nitric oxide degradation products were associated with a higher probability of rehospitalization during the two-year follow-up, while the increased activity of superoxide dismutase, together with reduced concentrations of thiol groups, malondialdehyde, and advanced oxida-tion protein products, have been associated with a poor intrahospital and two-year prognosis. Reduced serum potassium was a risk factor for in-hospital mortality. Multimarker integrative approach gives better insight into the pro-gnosis in patients with acute myocardial infarction, as well as the possibility of timely application of the adequate therapeutic procedu-res.