The effectiveness of modern immunomodulatory and cardiometabolic therapy in correction the risk of hospital complications in patients with acute myocardial infarction with myocardial revascularization: the results of multifactorial analysis

April 11, 2022
1238
Resume

Objective: to study the set of factors that determine the severity of inpatient acute myocardial infarction (AMI), and to assess the possibility of correcting the risk of complications by prescribing therapy with immunomodulatory/anti-inflammatory and cardiometabolic properties.

Materials and methods. The study involved 98 patients with AMI with elevation of the ST segment on the electrocardiogram. The main group of patients was divided into two similar clinical and anamnestic characteristics subgroups (73 and 25 individuals) depending on whether they received in addition to basic therapy complex cardiometabolic treatment (intravenous quercetin and oral trimetazidine).

Results. One-factor analysis revealed a protective effect (p<0.05) of the studied treatment on the risk of >2 hospital complications, while the most important risk factor for complications was the patient’s age (p=0.02). The multifactor analysis revealed a link between the risk of numerous hospital complications with the patient’s age, smoking and the value of the leukocyte-platelet index (LPI, developed by us in previous works) ≥150 c.u. on the 1st day of the disease (odds ratio (OR)=3.28 (95% CI 1.21–8.89), p=0.02), while the appointment of the treatment (intravenous quercetin and oral trimetazidine) has a positive effect on the hospital course of AMI (OR=0.29 (95% CI 0.10–0.86), p=0.026).

Conclusion. Appointment of therapy with intravenous quercetin and oral trimetazidine in elderly patients, smokers and patients with LPI ≥150 c.u. can be used as a single diagnostic and treatment package of measures to reduce the number of hospital complications, improve quality of life and reduce additional costs for the treatment of complications in patients with AMI.

References

  • 1. Virani S.S., Alonso A., Benjamin E.J. et al. (2020) Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation, 141(9): e139–e596. doi:10.1161/CIR.0000000000000757.
  • 2. Коваленко В.М., Корнацький В.М. (2016) Проблеми здоров’я і медичної допомоги та модель покращання в сучасних умовах: посібник для кардіологів, ревматологів, терапевтів, організаторів охорони здоров’я та лікарів загальної практики. Ін-т кардіол. ім. М.Д. Стражеска НАМН України. Друкарня «Гордон», Київ, 261 с.
  • 3. Granger C.B., Goldberg R.J., Dabbous O. et al. (2003) Predictors of hospital mortality in the global registry of acute coronary events. Arch. Intern. Med., 163(19): 2345–2353. doi:10.1001/archinte.163.19.2345.
  • 4. Fox K.A., Eagle K.A., Gore J.M. et al.; GRACE and GRACE2 Investigators (2010) The Global Registry of Acute Coronary Events, 1999 to 2009 — GRACE. Heart, 96(14): 1095–1101. doi:10.1136/hrt.2009.190827.
  • 5. Fox K.A., Fitzgerald G., Puymirat E. et al. (2014) Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open, 4(2): e004425. doi:10.1136/bmjopen-2013-004425.
  • 6. Hausenloy D.J., Yellon D.M. (2013) Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J. Clin. Invest., 123(1): 92–100. doi:10.1172/JCI62874.
  • 7. Lu L., Ma X., Zheng J. et al. (2020) Quercetin for myocardial ischemia reperfusion injury: A protocol for systematic review and meta-analysis. Medicine (Baltimore), 99(26): e20856. doi:10.1097/MD.0000000000020856.
  • 8. Lu J.,Meng Y., Wang R. et al. (2020) Anti-arrhythmogenic effects of quercetin postconditioning in myocardial ischemia/reperfusion injury in a rat model. J. King Saud Univ. Sci., 1910–1916. doi.org/10.1016/j.jksus.2020.01.038.
  • 9. Yan W., Song Y., Zhou L. et al. (2017) Immune Cell Repertoire and Their Mediators in Patients with Acute Myocardial Infarction or Stable Angina Pectoris. Int. J. Med. Sci., 14(2): 181–190. doi:10.7150/ijms.17119.
  • 10. Ibanez B., James S., Agewall S. et al. (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J., 39(2): 119–177. doi:10.1093/eurheartj/ehx393.
  • 11. Пархоменко А.М., Дзяк Г.В., Коваленко В.М. та ін. (2013) Рекомендації Асоціації кардіологів України щодо ведення пацієнтів з гострим коронарним синдромом з елевацією сегмента ST. Укр. кардіол. журн., додаток 3.
  • 12. Пархоменко А.М., Шумаков О.В., Талаєва Т.В. та ін. (2021) Нові можливості оцінювання ризику розвитку госпітальних ускладнень у хворих з гострим інфарктом міокарда з елевацією сегмента ST за даними вивчення клітинного складу крові. Укр. кардіол. журн., 28(1): 7–17. doi.org/10.31928/1608-635X-2021.1.717.
  • 13. López E., Sánchez-Margallo F.M., Álvarez V. et al. (2019) Identification of very early inflammatory markers in a porcine myocardial infarction model. BMC Vet. Res., 15(1): 91. doi:10.1186/s12917-019-1837-5.
  • 14. Valikeserlis I., Athanasiou A.A., Stakos D. (2021) Cellular mechanisms and pathways in myocardial reperfusion injury. Coron. Artery Dis., 32(6): 567–577. doi:10.1097/MCA.0000000000000997.
  • 15. Zhang Y.M., Zhang Z.Y., Wang R.X. (2020) Protective Mechanisms of Quercetin Against Myocardial Ischemia Reperfusion Injury. Front. Physiol., 11: 956. doi:10.3389/fphys.2020.00956.
  • 16. Bhat I.U.H., Bhat R. (2021) Quercetin: A Bioactive Compound Imparting Cardiovascular and Neuroprotective Benefits: Scope for Exploring Fresh Produce, Their Wastes, and By-Products. Biology (Basel.), 10(7): 586. doi:10.3390/biology10070586.
  • 17. Xue F., Nie X., Shi J. et al. (2017) Quercetin Inhibits LPS-Induced Inflammation and ox-LDL-Induced Lipid Deposition. Front. Pharmacol., 8: 40. doi:10.3389/fphar.2017.00040.
  • 18. Atrahimovich D., Samson A.O., Barsheshet Y. et al. (2019) Genome-wide localization of the polyphenol quercetin in human monocytes. BMC Genomics, 20(1): 606. doi:10.1186/s12864-019-5966.
  • 19. Pagliaro B.R., Cannata F., Stefanini G.G., Bolognese L. (2020) Myocardial ischemia and coronary disease in heart failure. Heart Fail Rev., 25(1): 53–65. doi:10.1007/s10741-019-09831-z.
  • 20. Chen Y.W., Chou H.C., Lin S.T. et al. (2013) Cardioprotective Effects of Quercetin in Cardiomyocyte under Ischemia/Reperfusion Injury. Evid. Based Complement. Alternat. Med.: 364519. doi:10.1155/2013/364519.
  • 21. Dagher O., Mury P., Thorin-Trescases N. et al. (2021) Therapeutic Potential of Quercetin to Alleviate Endothelial Dysfunction in Age-Related Cardiovascular Diseases. Front. Cardiovasc. Med., 8: 658400. doi:10.3389/fcvm.2021.658400
  • 22. Tabrizi R., Tamtaji O.R., Mirhosseini N. et al. (2020) The effects of quercetin supplementation on lipid profiles and inflammatory markers among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trials. Crit. Rev. Food Sci. Nutr., 60(11): 1855–1868. doi:10.1080/10408398.2019.1604491.
  • 23. Kallistratos M.S., Poulimenos L.E., Giannitsi S. et al. (2019) Trimetazidine in the Prevention of Tissue Ischemic Conditions. Angiology, 70(4): 291–298. doi:10.1177/0003319718780551.
  • 24. Liu Z., Chen J.M., Huang H. et al. (2016) The protective effect of trimetazidine on myocardial ischemia/reperfusion injury through activating AMPK and ERK signaling pathway. Metabolism, 65(3): 122–130. doi:10.1016/j.metabol.2015.10.022.
  • 25. Shehata M. (2014) Cardioprotective Effects of Oral Trimetazidine in Diabetic Patients With Anterior Wall Myocardial Infarction Treated with Thrombolysis. Cardiol. Res., 5(2): 58–67. doi:10.14740/cr330w.
  • 26. Wang C., Chen W., Yu M., Yang P. (2021) Efficacy of Trimetazidine in Limiting Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology, 72(6): 511–523. doi:10.1177/0003319720987745.