| Abstract | Uvod: U patofiziologiji infarkta miokarda značajnu ulogu ima vaskularna kalcifikacija.
Dosadašnje studije ukazuju da je Matriks Gla protein (MGP) jedan od važnijih čimbenika u
prevenciji vaskularne kalcifikacije, a povišene razine inaktivnog MGP-a povezane su s
povećanim rizikom nastanka aterosklerotskih plakova. Do sada nije istražena razina inaktivnog
MGP-a u bolesnika s akutnim infarktom miokarda sa ST elevacijom (STEMI) i infarktom
miokarda bez ST elevacije (NSTEMI) te povezanost s rizikom smrtnosti i velikih krvarenja u
bolesnika s infarktom miokarda.
Cilj: Cilj je ove studije bio usporediti razinu inaktivnog MGP-a u bolesnika s NSTEMI-jem u
odnosu na bolesnike sa STEMI-jem te ispitati povezanost razine dp-ucMGP-a s rizikom
smrtnosti i rizikom velikih krvarenja tijekom hospitalizacije.
Metode: Ukupno 90 ispitanika s dijagnozom akutnog infarkta miokada podijeljeno je u dvije
skupine - 46 ispitanika s dijagnozom STEMI-ja i 44 ispitanika s dijagnozom NSTEMI-ja.
Ispitanicima su određivane plazmatske vrijednosti dp-ucMGP-a i procijenjen rizik smrtnosti
pomoću GRACE bodovne ljestvice. Za određivanje rizika velikih krvarenja uključeno je 80
bolesnika s infarktom miokarda od čega 40 bolesnika sa STEMI-jem i 40 bolesnika s NSTEMIjem. Ispitivala se povezanost plazmatske razine inaktivnog MGP-a s rizikom krvarenja
procijenjenog CRUSADE bodovnom ljestvicom.
Rezultati: Plazmatska koncentracija dp-ucMGP-a bila je statistički značajno viša u skupini
ispitanika s NSTEMI-jem u usporedbi sa skupinom ispitanika sa STEMI-jem (1063,39 ± 518,58
vs. 742,74 ± 166,59 pmol/L, P < 0,001). U skupini ispitanika s NSTEMI-jem pronađene su
statistički značajno veće plazmatske vrijednosti dp-ucMGP-a u ispitanika s visokim rizikom
smrtnosti u odnosu na ispitanike s niskim rizikom smrtnosti procijenjene GRACE bodovnom
ljestvicom (1417,75 ± 956,78 vs. 984,64 ± 335,01 pmol/L, P = 0,03). Pronađena je statistički
značajna pozitivna korelacija plazmatske vrijednosti dp-ucMGP-a s dobi ispitanika (r = 0,259,
P = 0,014), vrijednostima kreatinina (r = 0,428, P < 0,001) te rizikom smrtnosti tijekom
hospitalizacije procijenjene GRACE bodovnom ljestvicom (r = 0,247, P = 0,019) u svih
ispitanika s infarktom miokarda. Utvrđeno je da su najznačajniji prediktori najviših plazmatskih
vrijednosti dp-ucMGP-a NSTEMI (6,19, 95 % CI 1,56-14,57) i pozitivna obiteljska anamneza
na kardiovaskularne bolesti (6,23, 95 % CI 1,80 – 15,64). U skupini ispitanika s NSTEMI-jem
utvrđen je značajno veći rizik velikog krvarenja procijenjen CRUSADE bodovnom ljestvicom
u odnosu na skupinu bolesnika sa STEMI-jem (P = 0,011). Pronađena je značajna pozitivna
korelacija između rizika velikog intrahospitalnog krvarenja procijenjenog CRUSADE bodovnom ljestvicom i vrijednosti plazmatskog dp-ucMGP-a (r = 0,442, P < 0,001). Statistički
značajno veće plazmatske koncentracije dp-ucMGP-a bile su u ispitanika s infarktom miokarda
s visokim i vrlo visokim rizikom velikih krvarenja procijenjenog CRUSADE bodovnom
ljestvicom u odnosu na ispitanike s niskim, vrlo niskim i umjerenim rizikom velikih krvarenja
(1277 vs. 794 pmol/L; P < 0,001, odnosno 1277 vs. 941 pmol/L, P = 0,047). Značajna pozitivna
korelacija bila je između rizika velikog intrahospitalnog krvarenja procijenjenog CRUSADE
bodovnom ljestvicom i rizika intrahospitalne smrtnosti procijenjene GRACE bodovnom
ljestvicom (r = 0,520, P < 0,001).
Zaključak: Ovo je istraživanje pokazalo da su plazmatske razine inaktivnog MGP-a bile
značajno više u bolesnika s NSTEMI-jem u odnosu na bolesnike sa STEMI-jem. Razine
inaktivnog MGP-a pokazale su pozitivnu korelaciju s rizikom smrtnosti i s rizikom velikih
krvarenja u bolesnika s infarktom miokarda. Istraživanje je potvrdilo dokaze o značajnoj ulozi
vaskularne kalcifikacije procijenjene mjerenjem plazmatske razine inaktivnog MGP-a u
patofiziologiji i riziku smrtnosti i velikih krvarenja u bolesnika s akutnim infarktom miokarda. |
| Abstract (english) | Background: Vascular calcification has an important role in myocardial infarction
pathophysiology. Current studies indicate that Matrix Gla protein is one of the most important
factors in vascular calcification inhibition, and that higher levels of inactive MGP are related to
a higher risk of atherosclerotic plaques formation. Until now, there have been no studies that
investigated the differences in the inactive MGP plasma level in Non ST Elevation Myocardial
Infarction (NSTEMI) and ST Elevation Myocardial Infarction (STEMI) patients and the
relation of inactive MGP plasma levels with the mortality risk and the risk of major bleeding in
patients with myocardial infarction.
Aim: The aim of this study was to compare plasma inactive MGP levels between patients with
NSTEMI and STEMI. The additional goal was to investigate the relationship of plasma dp-uc
MGP with the mortality risk and the risk of major bleeding during hospitalization.
Methods: This cross-sectional evaluation study of serum inactive MGP levels was conducted
on 90 patients with myocardial infarction - 46 patients with the STEMI diagnosis and 44 with
the NSTEMI diagnosis. Plasma dp-ucMGP levels were analyzed and in-hospital mortality risk
was assessed by the GRACE score. Furthermore, the evaluation study of the major bleeding
risk included 80 patients with myocardial infarction - 40 patients with the STEMI diagnosis and
40 with the NSTEMI diagnosis. The plasma dp-ucMGP levels with the major bleeding risk
assessed by CRUSADE score were examined.
Results: The dp-ucMGP plasma levels were significantly higher in the NSTEMI patients in
comparison to the STEMI patients (1063.39 ± 518.58 vs. 742.74 ± 166.59 pmol/L, P < 0.001).
Among the patients with NSTEMI, higher plasma levels of dp-ucMGP were associated with a
greater risk of in-hospital mortality assessed by the GRACE score (1417.75 ± 956.78 vs. 984.64
± 335.01 pmol/L, P = 0.03). Furthermore, there was a significant positive correlation between
the plasma dp-ucMGP levels with age (r = 0.259, P = 0.014), creatinine serum levels (r = 0.428,
P < 0,001), and in-hospital mortality risk assessed by the GRACE score (r = 0.247, P = 0.019)
in the total study population. The significant predictor of the highest tertile of the plasma dpucMGP levels were NSTEMI (OR 6.23, 95%, CI 1.80-15.64) and positive family history of
cardiovascular diseases (OR 6.19, 95%, CI 1.56-14.57). The NSTEMI patients had a
significantly higher major bleeding risk in comparison to the STEMI patients (P = 0.011). A
significant positive correlation was recorded between the major in-hospital bleeding risk
assessed by the CRUSADE score and plasma dp-ucMGP levels (r = 0.442, P < 0.001). The
patients at high/very high risk of major bleeding assessed by the CRUSADE score had significantly higher dp-ucMGP levels compared to the patients at very low/low and moderate
risk of major bleeding (1277 vs. 794 pmol/L; P < 0.001, respectively 1277 vs. 941 pmol/L, P =
0.047). A significant positive correlation was recorded between the major in-hospital bleeding
risk assessed by the CRUSADE score and in-hospital mortality risk assessed by the GRACE
score (r = 0.520, P < 0.001).
Conclusion: This study demonstrated that dp-ucMGP levels are significantly higher in the
NSTEMI patients in comparison to the patients with STEMI. Plasma dp-ucMGP levels
positively correlated with the mortality risk and the major bleeding risk in the patients with
myocardial infarction. This study suggests that vascular calcification assessed by the plasma
dp-ucMGP levels has an important role in pathophysiology, mortality risk and risk of major
bleeding in patients with myocardial infarction. |
