Prognostički značaj sistemskog inflamatornog odgovora kod bolesnika sa dijabetes melitusom tip 2 i akutnim infarktom miokarda sa elevacijom ST-segmenta koji su lečeni primarnom perkutanom koronarnom intervencijom
AuthorMilić, Veljko M.
Committee membersDeljanin Ilić, Marina
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INTRODUCTION: inflammation is associated with acute myocardial infarction and plays a key role in wound healing and scar formation. C-reactive protein and fibrinogen (CRP), acute phase inflammation phases are an accessible marker and are used in everyday clinical practice. The role of these biomarkers as prognostic factors for devel-oping heart failure and mortality on the acute myocardial infarction has already been investigated. Diabetes has long been known to be a risk factor for cardiovascular disease and is also associated with in-flammation. Patients experiencing myocardial infarction with eleva-tion of the ST segment (STEMI) undergo percutaneous coronary in-tervention (PKI), which itself is associated with an increased inflam-matory response. However, the difference in the inflammatory re-sponse between patients with and without diabetes who undergoes primary PKI is still not completely clear. METHODOLOGY: A total of 475 consecutive patients with the first myocardial infarction..., with and without diabetes, were subjected to primary PKI. C-reactive protein and fibrinogen sui from the patient's blood determined in the first 48 h and the maximum value was taken. A comparative analysis of coronary angiograms of both groups of pa-tients was performed and CRP and fibrinogen were examined as a prognostic factor for the primary and secondary study objectives. The primary goals are: hospital death, hospital coronary death, hospital reinfarction and mortality for all reasons for six months. Secondary goals are: composite outcome (coronary death, periprocedural cere-brovascular event, reinfark and repeated revascularization), systolic and diastolic left ventricular dysfunction discharge. The analysis of variance examined the importance of CRP and fibrinogen as a marker for future adverse events. RESULTS: Of the 475 patients with the first STEMI, 127 (26.7%) were diabetic patients and 348 (73.3%) were without diabetes. Pa-tients with diabetes have a significantly higher value of CRP and fi-brinogen compared to patients without diabetes [29.6 (10.4-91.8) ac-cording to 22.4 (9.79-49.2), p = 0.046 and 4.7 (3.6-6.3) to 4.3 (3.6-5.4), p = 0.026]. However, a multivariate analysis using the Cox re-gression model shows that in patients without diabetes CRP and fi-brinogen are independent prognostic biomarkers for hospital mortality [HR 1,013 95% CI (1,004-1,022), p = 0,004; HR 1,529 (1.023-2.287), p = 0.039]. In terms of six-month mortality, only CRP, not fibrinogen, showed a borderline prognostic significance [HR 1,013 95% CI (1,000-1,027), p = 0,048]. Total survival is lowest in the fourth quar-tile of CRP in patients without diabetes. CONCLUSION: elevated CRP values are a significant prognostic fac-tor for hospital and six-month mortality in patients without diabetes with the first STEMIs treated with primary PKI, but not for patients with diabetes. The lowest survival in the group without diabetes is in the fourth quartile of CRP. Fibrinogen can be used as an additional prognostic biomarker for hospital mortality.