THE INFLUENCE OF CELL AND PLASMA HEMOSTASIS AND BIOMARKER LEVELS ON CLINICAL OUTCOMES IN PATIENTS WITH UNSTABLE ANGINA AND RESISTANCE TO ANTIPLATELET AGENTS

Abstract

SUMMARY Objective: to assess the impact of cell plasma hemostasis disorders and the level of biomarkers on clinical outcomes and to develop laboratory diagnostic criteria forecast recurrent coronary events in patients with unstable angina. Material and Methods: the study included 124 patients with unstable angina. All patients were performed: complete blood count, to determine the level for TnI, the determination of inflammatory markers (hs C-reactive protein (CRP)), the level of myeloperoxidase, von Willebrand factor, the level of thrombin, fibrinogen (FG), antithrombin III (AT III), D-dimer, factor Xa), agregatogramm was performed an impedance aggregometer Multiplate and determining platelet activation by flow cytometry. All patients underwent ECG, echocardiogram, 24-hour ECG monitoring, coronary angiography. Results: developed independent predictors of the risk of recurrent coronary events in patients with unstable angina: the threshold values for evaluating platelet aggregation analyzer Multiplate-ASPI-test (AUC) >52 U, ADP-test (AUC) >60 U; the peak concentration of thrombin >294,5 nM, platelet size - MPV >9,6 fl, myeloperoxidase level >316 pmol/l, hsCRP >3.8 g/l, and troponin I >0,07 ng/ml. We created the scale of the prediction of recurrent coronary events after suffering unstable angina. In patients included to the study it was found that 18 patients (14.5%) recorded a decrease of sensitivity to aspirin (ASA)in the standard dose of 75 mg, in 24 patients (19.4%) to clopidogrel 75 mg and in 8 patients (6,5%) - both to ASA and clopidogrel. It was found that the resistance to ASA and/or clopidogrel more than 2.5 [CI, 2.0; 2.8] once increases the relative risk of recurrent ischemic events. Conclusions: developed by independent predictors of the risk of recurrent coronary events in patients with unstable angina: AUC ASPI- test>52 U, AUC ADP- test>60 U; the peak concentration of thrombin>294,5 nM, platelet size - MPV>9,6 fl, myeloperoxidase >316 pmol/l, high-sensitivity CRP >3.8 g/l, the level of troponin I>0,07 ng/ml. Keywords: unstable angina, resistance to ап^рШеШ agents, agregatogramm, cell and plasma hemostasis