Original research

DOI: http://doi.org/10.31928/2305-3127-2020.2.1827 

The prognostic role of vasculoendothelial growth factor A in patients with ST-segment elevation acute myocardial infarction during 6-months follow-up period

N.P. Kopytsya, I.M. Кutya, I.V. Rodionova, Ya.V. Hilova

L.T. Malaya Therapy National Institute of the NAMS of Ukraine, Kharkiv, Ukraine 

The aim to evaluate the prognostic role of vasculoendothelial growth factor A (VEGF-A) in patients with ST segment elevation acute myocardial infarction (STEMI) after successful revascularization during the 6-month follow-up period.

Materials and methods. We studied 135 patients with STEMI, 109 (80.7 %) men, 26 (19.3 %) women, average age (59.21 ± 8.92) years. The control group consisted of 30 healthy individuals. The blood flow was restored at the level of ТІМІ III in patients included in the study. The level of VEGF-A was determined by enzyme immunoassay. Blood for determining VEGF-A was taken on the 5-7th day of the disease.

Results. The level of VEGF-A in the main group was 247.94 [107.22–486.50] pg/ml. In the control group, the level of VEGF-A was 80.76 [56.20–149.51] pg/ml (p = 0.011). The selected group of patients who reached the combined endpoint included 29 (21.5 %) patients (group 1). The second group consisted of 106 people without cardiovascular events (group 2). LVEF (p = 0.002), E/E' diastolic dysfunction (p = 0.007), creatinine clearance (p = 0.018) were lower in the 1st group. The level of VEGF-A – 217.40 [102.54–473.78] pg/ml was significantly lower in the indicated (1st) group of patients versus 311.45 [204.20–680.86] pg/ml in the second group (p = 0.046). The threshold level of VEGF-A ≤ 255.72 pg/ml (area under the ROC curve 0.630; 95 % confidence interval 0.534–0.719; p = 0.0472) was determined. A biomarker concentration below this level with a sensitivity of 72 % and a specificity of 58 % has a negative prognostic value for 6 months after STEMI. Multivariate regression logistic analysis of predictors of the combined endpoint showed that the level of VEGF-A, LDL-C, and the complicated course of the acute MI period are predictors of the adverse course of the disease (p = 0.005).

Conclusions. In patients who reached the endpoint, a significantly lower concentration of VEGF-A was recorded (p = 0.011). A decrease in the level of VEGF-A < 255.72 pg/ml is a sensitive prognostic marker for the adverse course of the post-infarction period. The prognostic model for the development of adverse events during 6 months follow-up is constructed, with inclusion of the VEGF-A, LDL-C concentration and complications in the acute period of the disease, increases the accuracy of prediction power predominantly because of higher specificity.

Key words: vasculoendothelial growth factor-A, ST segment elevation acute myocardial infarction, prognosis.

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