Abstract
Objective
To identify independent predictors of the risk of recurrent cardiovascular events in patients (pts) with unstable angina (UA) in a conservative treatment strategy.
Material and methods
The study involved 236 patients with UA with low risk according to GRACE scale and conservative treatment strategy. The end points were: recurrent UA, myocardial infarction (MI), death. The mean age was 60.2±7.3 years. All pts were performed general blood analysis, determination of troponin I, BNP, C-reactive protein, myeloperoxidase, von Willebrand factor, fibrinogen, antithrombin III and also the performance of the thrombin generation test, aggregatogram on aggregometry Multiplate impedance and ECG, EchoCG, Holter ECG.
Results
Cardiovascular events developed in 104 (44%) pts during 5 years of follow-up, and in the first year of follow - up-in 58 people (24.6%), followed annually by 10–14% of events for the year. MI developed in 21 pts (8.9%), recurrent angina in 75 (31.8%) pts, 51 (21.6%) pts underwent coronary artery stenting, and 26 (11%) pts underwent coronary bypass surgery, 8 (3.4%) patients died. Having studied all the objective data of the observed patients, we concluded that independent predictors of the risk of recurrent cardiovascular events were: previous MI (RR=2,8; 95% CI 1,32–6,08; p=0,0028), type II Diabetes (RR=3,1; 95% CI 1,78- 5,37; p=0,0001), first-time angina pectoris (RR=3,7; 95% CI 2,68–5,85; p=0,001, smoking (RR=2,1; 95% CI 1,21–3,74; p=0,0129), baseline myeloperoxidase >316 pmol/l (RR=3,1; 95% CI 1,29–4,74; p=0,029), high sensitive CRP >3,8 g/l (RR=3,9; 95% CI 2, 44–6,14; p=0,0001), mean platelet volume >9,6fl (RR=2,9; 95% CI 1,49–5,52; p=0,0006), area under the curve ADP- test AUC >60 U (RR=3,4; 95% CI 2, 3–5,2; p=0,002).
Conclusions
Cardiovascular events developed in 44% of pts over 5 years of follow-up. Independent predictors of adverse outcomes in pts with UA with low risk according to GRACE scale were: previous MI, type II Diabetes mellitus, first-time angina pectoris, smoking, baseline myeloperoxidase levels>316 pmol/l, highly sensitive CRP>3.8 g/l, MPV>9.6fl, and the area under the ADP test curve >60 U.
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