Individualized approach to predicting complications of acute myocardial infarction in patients with chronic obstructive pulmonary disease

Objective. Development of an algorithm for predicting the complicated course of acute MI (rhythm disturbances, acute left ventricular failure: pulmonary edema, cardiogenic shock) in patients with COPD.

Materials and methods. 37 patients with acute myocardial infarction on the background of COPD were examined, undergoing inpatient treatment in the conditions of the regional vascular center of the State Budgetary Healthcare Institution of the Alexandro-Mariinsky Regional Clinical Hospital in 2017–2019. Clinical examination included assessment of complaints, life history and illness. The enzyme-linked immunosorbent assay was used to determine: the concentration of the HSP 70 protein using the HSP 70 High Sensitivity EIA Kits (Stressgen, USA), interleukins IL‑1β, IL‑2, IL‑6 with reagent kits of VEKTOR-BEST JSC (St. Novosibirsk, Russia) and neopterin test with the Neopterin ELISA kit (IBL International, Germany). Determination of the content of apoptotic cells from heparinized venous blood was performed using the Annexin-V-FITC / 7AAD reagent kit (Beckman Coulter, USA). Statistical data processing was carried out using the SPSS 26.0 (USA).

Results. When analyzing the frequency of occurrence of the studied laboratory diagnostic signs, significant differences were found for the indices of circulating annexin V mononuclear cells at an early stage of apoptosis and neopterin. Based on the data obtained and the selection of predictors, the probability of complications (rhythm disturbances, acute left ventricular failure) was calculated using the logistic regression equation. Using ROC analysis, a cut-off was determined for the levels of circulating annexin V mononuclear cells at an early stage of apoptosis and neopterin.

Conclusion. Information on the estimated high risk of developing complications of acute myocardial infarction, such as rhythm disturbances and acute left ventricular failure, will help to purposefully select the amount of preventive and therapeutic measures in patients with acute MI associated with COPD to minimize this risk.

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