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.