Clinical and Diagnostic Signifi cance of the Level of Biomarkers of Atherothrombosis and Hemostasis Instability in Patients with Unstable Angina
Introduction. The long-term prognosis for patients with acute coronary syndrome (ACS) remains unfavorable. According to the GRACE register, 5-year mortality among ACS survivors remains high, with no significant differences between ACS patients with ST elevation, non-ST elevation myocardial infarction, and unstable angina (19%, 22%, and 18%, respectively). The problem of identifying individuals with unstable angina and poor prognosis, who need timely myocardial revascularization in order to reduce the number of repeated cardiovascular events and to increase survival, is particularly important. Purpose. To study the clinical and diagnostic significance of atherothrombosis biomarkers and hemostasis instability in patients with unstable angina (UA) to develop additional diagnostic laboratory criteria for the presence of unstable atherosclerotic plaque. Materials and methods. The study included 456 patients; 196 patients with UA - group 1 (MG1), 170 patients with coronary heart disease: FC II-III angina pectoris with unstable angina during the past year (MG2), and 90 individuals with chronic coronary artery disease: angina pectoris FC III (CG), without a history of UA. All patients underwent laboratory tests to assess the biomarkers of atherothrombosis and hemostatic instability. All patients also underwent EchoCG, invasive coronary angiography, intravascular ultrasound (IVUS), and optical coherence tomography (OCT) as indicated. Results and discussion. Among patients with unstable angina, 70% of people have low risk on the GRACE scale. According to coronary angiography, IVUS or OCT, instability of atherosclerotic plaque was detected in 65.3% of patients with UA, in 48.8% of patients who had UA during the year, and in 5% of patients with stable angina of FC III. Threshold values of additional diagnostic laboratory parameters for diagnostics of unstable atherosclerotic plaque were the following: myeloperoxidase level (MPO) >316 pmol/L, hsCRP>5.8 mg/L, peak thrombin concentration ≥294.5 nM, endogenous thrombin potential≥294.5 nm×min, platelet volume MPV>9.1 fl, von Willebrand factor >145%, and AUC of the ADP test >60 U.Conclusions. Laboratory parameters (MPO>316 pmol/l, hsCRР>5,8 mg/l, peak thrombin concentration ≥1598.7 nM, endogenous thrombin potential ≥294.5 nM×min, MPV>9.1 fl, von WF>145%, AUC ADP test >60 U) can be used as additional diagnostic laboratory criteria for the presence of unstable atherosclerotic plaque in patients with UA and in persons with UA, who suffered during the year.