Adhesion Molecules in Assessment of Annual Prognosis in Young Patients with Acute Coronary Syndrome

Aim. To study the place and role of adhesive molecules (E-, L-, P-selectins, intercellular and vascular adhesion molecules of type 1 — ICAM-1, VCAM-1) in development of unfavorable one-year prognosis in young patients with acute coronary syndrome (ACS).

Material and methods. A 12-month prospective follow-up included 95 patients (90 men, 5 women, mean age 41.00 [39.00-43.00] years) with ACS who underwent percutaneous coronary intervention (PCI). The endpoints were evaluated (primary — cardiovascular death, and combined secondary — nonfatal acute myocardial infarction and acute cerebrovascular accident, emergency hospitalization due to cardiovascular causes — unstable angina, arrhythmias, heart failure). Blood concentrations of E-, L-, P-selectins, ICAM-1, VCAM-1 were determined by enzyme immunoassay on the 1st (before PCI) and on the 7th day of hospitalization (after PCI).

Results. During 12 months, 22 (23.16 %) patients had estimated endpoints: death in 2 (2.1 %) patients, nonfatal myocardial infarction in 6 (6.32 %), hospitalization due to unstable angina in 14 (14.73 %). In ACS patients with unfavorable annual prognosis, the levels of leukocytes, P-selectin and ICAM-1 on day 1 (before PCI), L- and P-selectins on day 7 (after PCI) were significantly higher than in patients with favorable annual period. According to multivariate analysis, predictors of unfavorable annual prognosis in young ACS patients were the levels of leukocytes (p=0.020) and ICAM-1 (p=0.010) on day 1 (before PCI) and L-selectin on day 7 after PCI (p=0.040).

Conclusion. During the first 12 months in young ACS patients the most significant factors of unfavorable prognosis are the levels of blood leukocytes and ICAM-1 on day 1 (before PCI), and L-selectin on the 7th day after percutaneous coronary intervention.

1. Shal’nev V.I. Acute coronary syndrome: how to reduce the residual inflammatory risk? Russian Journal of Cardiology. 2020; 25(2): 113-118. doi: 10.15829/1560-4071-2020-2-3720. [In Russian].

2. Marcevich S.Yu., Afonina O.S., Zagrebel’nyj A.V., et al. Comparative assessment of long-term survival of patients after primary and recurrent myocardial infarction: a data from the RIMIS registry. Cardiovascular Therapy and Prevention. 2024; 23(5): 25-33. doi: 10.15829/1728-8800-2024-4001. [In Russian].

3. Hazova E.V., Bulashova O.V. Residual risk in patients with atherosclerotic cardiovascular disease. Cardiovascular Therapy and Prevention. 2023; 22(1): 94-104. doi: 10.15829/1728-8800-2023-3382. [In Russian].

4. Basalaj O.N., Bushma M.I., Borisenok O.A. Role of inflammation in the pathogenesis of ischemic heart disease and myocardial infarction. Meditsinskie novosti. 2020; 6: 13-18. [In Russian].

5. Hayek A., Paccalet A., Mechtouff L., et al. Kinetics and prognostic value of soluble VCAM-1 in ST-segment elevation myocardial infarction patients. Immunity, Inflammation and Disease. 2021; 9(2): 493-501. doi: 10.1002/iid3.409.

6. Mal’ceva A.N., Kosinova A.A., Grinshtejn Yu.I. The role of leukocyte-platelet interaction and the level of P-selectin in genesis of atherosclerosis and outcomes in patients with cardiovascular pathology. Zabajkal’skij medicinskij vestnik. 2020; 2: 104-114. [In Russian].

7. Yu J., Liu Y., Peng W., et al. Serum VCAM-1 and ICAM-1 measurement assists for MACE risk estimation in ST-segment elevation myocardial infarction patients. Journal of Clinical Laboratory Analysis. 2022; 36(10): e24685. doi: 10.1002/jcla.24685.

8. Zamani P., Schwartz G.G., Olsson A.G., et al. Myocardial ischemia reduction with aggressive cholesterol lowering (MIRACL) study investigators. Inflammatory biomarkers, death, and recurrent nonfatal coronary events after an acute coronary syndrome in the MIRACL study. Journal of the American Heart Association. 2013; 2(1): e003103. doi: 10.1161/JAHA.112.003103.

9. Zhang J., Xu H., Yao M., et al. The abnormal level and prognostic potency of multiple inflammatory cytokines in PCI-treated STEMI patients. Journal of Clinical Laboratory Analysis. 2022; 36(11): e24730. doi: 10.1002/jcla.24730.

10. Andreenko E.Yu., Yavelov I.S., Luk’yanov M.M., et al. Ischemic heart disease in subjects of young age: current state of the problem. Prevalence and cardio-vascular risk factors. Kardiologiia. 2018; 58(10): 53-58. doi: 10.18087/cardio.2018.10.10184. [In Russian].

11. Shushanova A.S., Gladkih N.N., Yagoda A.V. Myocardial infarction type 1 in young patients: contribution of proatherogenic factors and genetic thrombophilia. Therapy. 2023; 9(4): 30-37. doi: 10.18565/therapy.2023.4.30–37. [In Russian].

12. Özcan C., Deleskog A., Schjerning O. A-M., et al. Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study. European Heart Journal — Cardiovascular Pharmacotherapy. 2018; 4(1): 25-35. doi: 10.1093/ehjcvp/pvx009.

13. Opincariu D., Rodean I., Rat N., et al. Systemic vulnerability, as expressed by I-CAM and MMP-9 at presentation, predicts one year outcomes in patients with acute myocardial infarction-insights from the VIP Clinical Study. Journal of clinical medicine. 2021; 10(15): 3435. doi: 10.3390/jcm10153435.

14. Abdrahmanova A.I., Amirov N.B., Kim Z.F., et al. C-reactive protein in acute coronary syndrome: content in blood plasma and prognostic value. The Bulletin of Contemporary Clinical Medicine. 2019; 12(1): 79-85. doi: 10.20969/VSKM.2019.12(1).79-85. [In Russian].

15. Panina A.V., Dolotovskaya P.V., Puchin’yan N.F., et al. Leukocytosis and clinical outcomes in patients with myocardial infarction with ST-segment elevation. Saratovskij nauchno-medicinskij zhurnal. 2013; 9(4): 673-678. [In Russian].