Predictive Value of Inflammatory Mediators and Effectors in Coronary Atherosclerosis - Its Link with Adverse Outcomes of Percutaneous Coronary Intervention

Introduction. Progress of interventional cardiology causes decrease of CHD complications, but new problems such as late thrombosis and stent restenosis, as well as neoarterogenesis were come in sight. According the literature data, stent thrombosis after percutaneous coronary intervention (PCI) developed in 0,5-1,5% of cases, restenosis if stent due neointimal hyperplasia a – in 2-10%, frequency of recurrent coronary interventions – 6-23%, that depends on type of stent (drug eluting stents with everolimus or bare metalic stents). The “latecatchup” fenomen caused weak and long inflammation, that can cause this complications. Aim of research was to study the level of inflammatory effectors and mediators in 164 patients with coronary atherosclerosis and to establish their prognostic value in major adverse coronary events (MACE) development in the long-term period after the percutaneous coronary intervention (PCI). Material and methods. The study included 164 patients with coronary atherosclerosis (CA), who were treated at the State Institution “Republican Specialized Scientific Practical Medical Centre of Surgery named after academician V. Vakhidov” in the period from 2012-2017. All patients had CHD, stable angina of functional class 3 (FC-III) according to the classification of The Canadian Cardiovascular Society (CCS). ROC – analysis was performed and area under curve were evaluated for CRP, VEGF, TNF-a, IL-6. Results. According to the results of ROC-analysis, the following markers have a predictive value in determining the risk of MACE 12 months after the PCI: baseline level of VEGF, IL-6; the threshold level for predicting an unfavorable long-term PCI result for IL -6 - is more than 17 pg/ml; for VEGF - more than 98.5 pg/ml. An increase in the concentration of CRP from 1 to 5 days after PCI, as well as a consistently high level of IL-6 and TNF-a within 5 days after PCI are associated with a high risk of MACE; high quality test found for CRP delta between 1 and 5 days after PCI (AUC=0.809 (95% CI: 0.686 to 0.899), with 71% sensitivity, 98% specificity.