ПЕРСОНИФИЦИРОВАННЫЙ ПОДХОД К ОЦЕНКЕ РИСКА РАЗВИТИЯ ПОВТОРНЫХ СЕРДЕЧНО-СОСУДИСТЫХ СОБЫТИЙ И ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕК У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА И ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК

Abstract

Introduction: AKI (acute kidney injury) is a common comorbid condition in patients with AMI (acute myocardial infarction), complicating its course and treatment. In the future, the prognosis of these patients after discharge from the hospital, as well as the incidence of recurrent cardiovascular events (CVS) and chronic kidney disease (CKD) are not known. The purpose of the study: to study the predictors of the development of recurrent cardiovascular events (CVS) in patients with myocardial infarction (MI) with acute kidney injury (AKI). Develop a calculator - a risk meter for repeated CCC. Materials and methods: the study was performed in the Altai Regional Cardiological Dispensary. 193 patients with MI and PCI (percutaneous coronary intervention) were included, divided into 2 groups: the first - 123 patients aged 62.8±1.1 years with MI and AKI, the second - 70 patients without AKI, age 61.3± 1.6 years. Upon admission and before discharge, the level of the KIM-1 molecule (Kidney Injury Molecule-1) and IL-18 (interleukin-18) was studied by ELISA in the urine. All patients underwent coronary angiography using low-osmolar contrast. One year after discharge, the frequency of development of repeated CCC was assessed. Statistical calculations were carried out using statistical packages STATISTICA 12.0. The level of statistical significance was taken equal to 0.05. Results. The level of KIM-1 (at admission) in the first group was statistically higher than in the second: 1998.9±147.6 versus 1289.8±126.1 pg/ml p=0.001, and IL-18 in the AKI group exceeded the corresponding parameter of the group without AKI: 179.0±12.9 versus 114.9±11.5 pg/ml p=0.007, respectively. A year later, it was found that the frequency of recurrent cardiovascular events was higher in the group with AMI and AKI: unstable angina was diagnosed in 26 (21.1%) patients in the group with AKI and 5 (7.1%) patients without AKI in history, p=0.010; 19 (15.4%) and 2 (2.8%) patients, p=0.006, 20 (16.2%) and 3 (4.2%), p=0.013 patients, respectively, had repeated myocardial infarction and progression of CHF in a year . Progression of renal dysfunction during the year was observed 5 times more often in patients with MI and AKI: CKD C2 was diagnosed in 49 (39.8%) patients of the first group and 16 (22.8%) of the second, p = 0.01; CKD C3a and C3b stages - in 34 (27.6%), p˂0.001 and 19 (15.4%) patients, p=0.002, respectively, CKD stage C4 was detected in 4 (3.2%) patients of the group with AMI and AKI in the early postinfarction period. As a result of constructing a multifactorial logistic regression model, predictors were identified that have a multiplicative effect on the development of recurrent CV events: BMI over 25 kg/m2 increases the risk of recurrent CV events by 0.91 [0.83; 0.99] times, p=0.028, history of prior MI in 3.32 [1.24; 9.86] times, p=0.022. Increase in CRP by 1.01 [1; 1.03] times, p=0.045, troponin I, 0.97 [0.94;1] times, p=0.037, and IMT-1, 1 [1;1] times, p=0.030. On the development of CKD: an increase in age is associated with an increase in the chances of developing CKD by 1.18 [1.1; 1.29], p ˂0.001; troponin I by 0.96 times [0.92; 1], p=0.030; systolic blood pressure in 1.03 [1; 1.07] times, p = 0.029. A calculator has been developed for risk stratification of the development of recurrent CV events and an algorithm for managing this category of patients after discharge from the hospital. Conclusions: thus, the identified predictors make it possible to calculate the risk of developing recurrent CV events and CKD using the developed calculator and allocate these patients to a separate group for personalized observation, taking appropriate measures of secondary prevention.