VZL 2007, 76(3):73-82

The Prognostic Stratification of Patients Suffering from the Ischemic Heart Disease Through the Non-Invasive Coronarography and Selected Biochemical Parameters and the Possibility to Influence It

Miroslav Martinkovič1, Peter Prečinský2, Pavol Blažíček3
1 Interné oddelenie, Nemocnica Ministerstva obrany, Bratislava, Slovenská republika
2 Rádiodiagnostické oddelenie, Nemocnica Ministerstva obrany, Bratislava, Slovenská republika
3 Oddelenie klinických laboratórií, Nemocnica Ministerstva obrany, Bratislava, Slovenská republika

Nestabilný plát hrá kľúčovú úlohu v rozvoji akútnych koronárnych syndrómov (AKS). Možnosť jeho detekcie a terapeutického ovplyvnenia významne ovplyvňuje prognostickú stratifikáciu pacientov s ischemickou chorobou srdca (ICHS).
Cieľom práce je pomocou vybraného sérového zápalového ukazovateľa, lipidového spektra a neinvazívnej koronarografie posúdiť možnosti detekcie nestabilných plátov v koronárnom riečisku a jej využitie v sekundárnej prevencii. Súbor tvorilo 107 chorých s rôznymi formami ischemickej choroby srdca, ktorí boli podľa diagnóz a koronarografických nálezov rozdelení do 4 základných skupín. U všetkých sme vyšetrili sérové hladiny hsC-reaktívneho proteinu a lipidové spektrum.
Zistili sme výrazne vyšší výskyt mäkkých nestabilných plátov a sérovej hladiny hsC-reaktívneho proteinu u pacientov s akútnym koronárnym syndrómom. Prítomnosť mäkkých nestabilných plátov bola signifikantne asociovaná so zvýšenými hladinami C-reaktívneho proteinu a celkového cholesterolu. Po nasadení "plát stabilizujúcej" liečby došlo vo všetkých laboratórnych parametroch k signifikantnej zmene v čase. Pri porovnaní hladín CRP sa ukázalo, že rozdiel sa nachádza medzi skupinami AKS a ICHS (p < 0,01), ale nie medzi skupinami s kalcifikovanou koronárnou aterosklerózou a nestabilným plátom. Výskyt AKS ani úmrtí na náhlu srdcovú smrť počas doby sledovania nebol asociovaný s prítomnosťou nestabilných plátov ani diagnózy. Analýzou priebehu sérových hladín hs CRP sme zistili, že výskyt sledovaných komplikácií bol spojený s úrovňou hs CRP nad 2 mg/l.

Záver: Naša "plát stabilizujúca" liečba sprevádzaná signifikantnými zmenami v sérových hladinách sledovaných laboratórnych parametrov vyrovnala riziko akútnych komplikácií medzi všetkými podskupinami súboru. Takáto liečba nedokáže eliminovať akútne komplikácie ICHS, ale v prípadoch verifikovaných nestabilných plátov dokáže účinne znížiť riziko ich výskytu.

Keywords: Nestabilný plát; Neinvazívna koronarografia; Zápalový marker

The unstable plaque plays a key role in the development of acute coronary syndromes. The possibility of its detection and therapeutic influence significantly affects the prognostic stratification of the ischemic heart disease (IHD).The objective of this paper is to examine, using the selected serum inflammatory marker, the lipid spectrum, and the non-invasive coronarography, the possibility of detection of unstable plaques in the coronary bed and its use in the secondary prevention. The set consisted of 107 patients with various forms of ischemic heart disease divided into four basic groups according to diagnosis and coronarographic findings. All the patients have been tested for the serum levels of the hsC-reactive protein and the lipid spectrum.We have detected a substantially higher occurrence of soft unstable plaques and serum level of hsC-reactive protein in patients with the acute coronary syndrome. The presence of the soft unstable plaques was significantly associated with the increased levels of the C-reactive protein and the total level of cholesterol. A significant change in time for all the laboratory parameters occurred after the application of the "plaque-stabilizing" treatment. The comparison of the levels of the C-reactive protein demonstrated a difference between the acute coronary syndrome and ischemic heart disease groups (p < 0.01) but there is no difference between the groups with the calcified coronary atherosclerosis and unstable plaque. The occurrence of the ACS and sudden cardiac death during the time of research was not associated with the existence of unstable plaques or diagnosis. We have found out through the progress analysis of the serum levels of hsC- reactive protein that the existence of the monitored complications was associated with the level of the hsC-reactive protein above 2 mg/l.

Conclusion: Our "plaque-stabilizing" treatment accompanied with significant changes in the serum levels of the laboratory monitored parameters has balanced the risk of acute complications in all the sample subgroups. Such treatment is not able to eliminate the acute complications of the ischemic heart disease but, in the case of the verified unstable plaques, it can effectively decrease the risk of their occurrence.

Keywords: Unstable plaque; Non-invasive coronarography; Inflammatory marker

Received: November 7, 2006; Published: September 1, 2007  Show citation

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Martinkovič, M., Prečinský, P., & Blažíček, P. (2007). The Prognostic Stratification of Patients Suffering from the Ischemic Heart Disease Through the Non-Invasive Coronarography and Selected Biochemical Parameters and the Possibility to Influence It. Vojenské Zdravotnické Listy, 76(3), 73-82
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