PROGNOSIS OF SIGNIFICANT ISCHEMIC EVENTS AND LETHAL OUTCOME IN PATIENTS WITH MYOCARDIAL INFARCTION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Authors:   Astrakhan State Medical University, PROKOFYEVA TATIANA V. , POLUNINA OLGA S. ,   Astrakhan State Medical University, POLUNINA EKATERINA A. ,   Astrakhan State Medical University
Published: October 2023

Introduction. Myocardial infarction remains significant due to its high prevalence and disability. Of particular importance is the prediction of the risk of adverse events in myocardial infarction patients with cardiorespiratory comorbidity, in particular with chronic obstructive pulmonary disease. It can be assumed that endogenous intoxication syndrome can be considered as a predictor of life-threatening events (repeated myocardial infarction, stroke) and lethal outcome in patients with myocardial infarction against chronic obstructive pulmonary disease. Aim. The aim is to determine the probability of combined endpoint development (repeated myocardial infarction, stroke, lethal outcome) in patients with myocardial infarction against chronic obstructive pulmonary disease during 12-month follow-up depending on gender-anamnestic and clinical-functional characteristics. Material and methods. We examined 325 patients with myocardial infarction - 195 patients with myocardial infarction against chronic obstructive pulmonary disease and 130 patients with myocardial infarction without chronic obstructive pulmonary disease (comparison group). As markers of endogenous intoxication syndrome, we studied middle weight molecules, hematological intoxication indices, blood gas indices, apoptosis, protein and lipid peroxidation and antioxidant protection, inflammation and renal function. Statistical data processing was performed using SPSS 26.0 software package. Results and discussion. Two-stage cluster analysis resulted in four clusters characterizing the type of endogenous intoxication syndrome: «polymarker-retentive», «necrotic- inflammatory», «hypoxic-inflammatory» and a cluster with no endogenous intoxication syndrome. The polymarker- retentive type of endogenous intoxication syndrome prevailed among patients with myocardial infarction against chronic obstructive pulmonary disease. Recurrent myocardial infarction, stroke and mortality constituted the combined endpoint. A decision tree was constructed to determine the probability of developing the combined endpoint in patients with myocardial infarction against the background of chronic obstructive pulmonary disease during the 12-month follow-up. It was found that the most significant predictors of combined endpoint occurrence are polymarker-retentive type of endogenous intoxication syndrome, the presence of acute infarction period complications and pronounced bronchoobstruction (degree 3-4). Conclusion. The constructed decision tree allows to stratify patients with high risk of repeated infarction, stroke and lethal outcome during the first year of follow-up after myocardial infarction against chronic obstructive pulmonary disease without increasing economic costs, which promotes optimization of treatment and secondary prevention in this category of patients.