MD840Z

MD840Z - Method for predicting the risk of death in the post-infarction period of acute myocardial infarction

Info

Publication number: MD840Z
Application number: MDS20140067A
Authority: MD
Inventors: Константин ЖУКОВСКИЙ; Лилия ДАВИД; Аурел ГРОСУ
Original assignee: Константин ЖУКОВСКИЙ; Лилия ДАВИД; Аурел ГРОСУ
Priority date: 2014-05-15
Filing date: 2014-05-15
Publication date: 2015-06-30
Also published as: MD840Y

Abstract

The invention relates to medicine, in particular to cardiology, and can be used for predicting the risk of death in the post-infarction period of acute myocardial infarction.According to the invention, the claimed method consists in that from the patient, on the 10th day of hospitalization, is taken a blood sample, in which is determined the concentration of C-reactive protein and malondialdehyde, then, per os, is administered a solution containing 75 g of glucose and 250 ml of water, afterwards, after 120 minutes, is taken another blood sample, in which is determined the glycemia and in the case when glycemia is above 8.7 mmol/l, the concentration of C-reactive protein is above 9.8 mg/l and of malondialdehyde above 3.51 µM/l is predicted an increased risk of mortality, and in the case when glycemia corresponds to the values 7.7…8.7 mmol/l, the concentration of C-reactive protein is of 3.0…9.8 mg/l and of malondialdehyde of 1.9…3.51 µM/l - an average risk of mortality, and when glycemia is below 7.7 mmol/l, the concentration of C-reactive protein below 3.0 mg/l and of malondialdehyde below 1.9 µM/l - a minimum risk of mortality.

Description

Invenţia se referă la medicină, în special la cardiologie, şi poate fi utilizată pentru pronosticarea riscului de deces în perioada de postinfarct miocardic acut. The invention relates to medicine, in particular to cardiology, and can be used to predict the risk of death in the post-acute myocardial infarction period.

Studii recente au demonstrat că tulburările de glicoreglare subclinice, inclusiv toleranţa anormală la glucoză, care poate fi evidenţiată doar utilizând testul oral de toleranţă la glucoză (TOTG), sunt foarte frecvente la bolnavii cu infarct miocardic acut (IMA). De asemenea s-a constatat că aceşti pacienţi au un pronostic postinfarct mai sever comparativ cu cei cu toleranţă normală la glucoză şi un risc de mortalitate semnificativ mai crescut. Sunt puţine studii în care s-a analizat pronosticul pe termen lung după IMA la această categorie de pacienţi şi doar în câteva au fost cercetaţi factorii care influenţează pronosticul. În studiul realizat de un grup de autori japonezi pe un grup de 275 de pacienţi cu IMA a fost propusă stratificarea riscului la bolnavii cu IMA şi toleranţă la glucoză după rezultatul TOTG fiind definit nivelul glicemiei post-încărcare de la care probabilitatea de deces postinfarct creşte [1]. Recent studies have shown that subclinical glycoregulation disorders, including abnormal glucose tolerance, which can only be demonstrated using the oral glucose tolerance test (OGTT), are very common in patients with acute myocardial infarction (AMI). It was also found that these patients have a more severe post-infarction prognosis compared to those with normal glucose tolerance and a significantly higher risk of mortality. There are few studies that have analyzed the long-term prognosis after AMI in this category of patients and only a few have investigated the factors that influence prognosis. In the study conducted by a group of Japanese authors on a group of 275 patients with AMI, risk stratification was proposed in patients with AMI and glucose tolerance according to the OGTT result, defining the post-load glycemia level from which the probability of post-infarction death increases [1].

Dezavantajul metodei constă în aceea că a fost utilizat doar un parametru pentru pronosticarea riscului, ceea ce uneori nu este îndeajuns pentru a determina un rezultat obiectiv în perioada de postinfarct, adică după externarea pacienţilor din staţionar. The disadvantage of the method is that only one parameter was used to predict risk, which is sometimes not enough to determine an objective result in the post-infarction period, that is, after patients are discharged from the hospital.

Problema pe care o rezolvă metoda propusă constă în elaborarea unui model de pronosticare a decesului în perioada postinfarct la bolnavii care au suportat un infarct miocardic acut asociat cu tulburări glicemice utilizând parametri biochimici uşor de preluat, care să permită stratificarea riscului la aceşti pacienţi, ceea ce contribuie la optimizarea selectării strategiilor terapeutice şi la îmbunătăţirea pronosticului. The problem that the proposed method solves consists of developing a model for predicting death in the post-infarction period in patients who have suffered an acute myocardial infarction associated with glycemic disorders using easy-to-take biochemical parameters, which allow risk stratification in these patients, which contributes to optimizing the selection of therapeutic strategies and improving the prognosis.

Conform invenţiei, metoda revendicată constă în aceea că de la pacient, în ziua a 10-a de la internare, se prelevă o probă de sânge, în care se determină concentraţia proteinei C reactive şi a dialdehidei malonice, apoi, per os, se administrează o soluţie care conţine 75 g de glucoză şi 250 ml de apă, după care, peste 120 min, se prelevă o altă probă de sânge, în care se determină glicemia şi atunci când glicemia este mai mare de 8,7 mmol/l, concentraţia proteinei C reactive mai mare de 9,8 mg/l şi a dialdehidei malonice mai mare de 3,51 µM/l se pronostichează un risc înalt de deces, în cazul în care glicemia corespunde valorilor 7,7…8,7 mmol/l, concentraţia proteinei C reactive este de 3,0…9,8 mg/l şi a dialdehidei malonice de 1,9…3,51 µM/l - risc mediu de deces, iar când glicemia este mai mică de 7,7 mmol/l, concentraţia proteinei C reactive mai mică de 3,0 mg/l şi a dialdehidei malonice mai mică de 1,9 µM/l - un risc scăzut de deces. According to the invention, the claimed method consists in that a blood sample is taken from the patient, on the 10th day after admission, in which the concentration of C-reactive protein and malonic dialdehyde is determined, then, per os, a solution containing 75 g of glucose and 250 ml of water is administered, after which, after 120 min, another blood sample is taken, in which the blood sugar is determined and when the blood sugar is higher than 8.7 mmol/l, the concentration of C-reactive protein higher than 9.8 mg/l and of malonic dialdehyde higher than 3.51 µM/l, a high risk of death is predicted, if the blood sugar corresponds to the values 7.7…8.7 mmol/l, the concentration of C-reactive protein is 3.0…9.8 mg/l and of malonic dialdehyde of 1.9…3.51 µM/l - medium risk of death, and when blood sugar is less than 7.7 mmol/l, C-reactive protein concentration less than 3.0 mg/l and malondialdehyde concentration less than 1.9 µM/l - a low risk of death.

Rezultatul invenţiei constă în elaborarea unei metode de pronosticare a riscului de mortalitate în perioada postinfarct la bolnavii care au suportat infarct miocardic acut, modelul fiind simplu în aplicare cu utilizarea unor parametri uşor de preluat şi estimat şi având ca scop îmbunătăţirea abordării individualizate a bolnavilor cu IMA prin selectarea complexă a recomandărilor terapeutice de rigoare. The result of the invention consists in developing a method for predicting the risk of mortality in the post-infarction period in patients who have suffered acute myocardial infarction, the model being simple to implement using parameters that are easy to take and estimate and aiming to improve the individualized approach to patients with AMI through the complex selection of appropriate therapeutic recommendations.

Avantajul metodei propuse este determinat de simplicitatea acesteia, care se datorează antrenării unor parametri paraclinici uşor de obţinut, la fel metoda revendicată permite pronosticarea timpurie a probabilităţii evoluţiei fatale a bolii la pacienţii cu IMA şi face posibilă stratificarea subiecţilor în funcţie de riscul de deces, şi respectiv abordarea individualizată a bolnavilor şi optimizarea strategiilor terapeutice aplicate, ca rezultat obţinându-se ameliorarea pronosticului la această categorie de bolnavi. The advantage of the proposed method is determined by its simplicity, which is due to the training of easy-to-obtain paraclinical parameters, as well as the claimed method allows early prediction of the probability of fatal evolution of the disease in patients with AMI and makes it possible to stratify subjects according to the risk of death, and respectively the individualized approach to patients and the optimization of the applied therapeutic strategies, as a result of which the prognosis in this category of patients is improved.

Metoda se realizează în modul următor: se efectuează TOTG înainte de externare din spital (în medie ziua a 10-a) cu preluarea a două probe de sânge din vena cubitală înainte şi după 120 min de la ingestia a 75 g de glucoză dizolvată în 250 ml de apă, în prima probă de sânge se determină glucoza, hs-proteina C reactivă (PCR) şi dialdehida malonică (DAM), iar în cea de a doua - doar glicemia. Evaluarea va lua în calcul: nivelul glicemiei din proba a doua (după încărcarea cu glucoză) şi valorile PCR şi DAM din prima probă de sânge. Utilizarea analizei multivariate prin modelul riscului proporţional Cox a identificat DAM şi PCR ca factori independenţi de pronostic ai mortalităţii pentru pacienţii cu IMA. Astfel, pentru DAM a fost stabilit HR=2,632 (95% CI: 1,292…5,358), p<0,01 şi pentru PCR riscul a constituit HR = 2,394 (95% CI: 1,005…5,741), p < 0,05. Datele obţinute denotă creşterea riscului pentru o evoluţie fatală a bolii în perioada postinfarct mai bine de două ori la pacienţii cu concentraţii sporite ale indicatorului stresului oxidativ - dialdehida malonică, la fel ca şi în cazul augmentării nivelului PCR. The method is performed as follows: TOTG is performed before hospital discharge (on average day 10) with two blood samples taken from the cubital vein before and after 120 min after ingestion of 75 g of glucose dissolved in 250 ml of water, in the first blood sample glucose, hs-C-reactive protein (CRP) and malondialdehyde (MDA) are determined, and in the second - only blood glucose. The evaluation will take into account: the blood glucose level in the second sample (after glucose loading) and the CRP and MDA values in the first blood sample. The use of multivariate analysis using the Cox proportional hazards model identified MDA and CRP as independent prognostic factors of mortality for patients with AMI. Thus, for DAM it was established HR=2.632 (95% CI: 1.292…5.358), p<0.01 and for CRP the risk was HR=2.394 (95% CI: 1.005…5.741), p<0.05. The data obtained denote an increase in the risk for a fatal evolution of the disease in the post-infarction period more than twice in patients with increased concentrations of the oxidative stress indicator - malonic dialdehyde, as in the case of increased CRP levels.

Exemple concrete de realizare Concrete examples of implementation

Exemplul 1 Example 1

Pacientul S., 53 ani, hipertensiv, supraponderal, fumător, a fost spitalizat cu dureri anginoase, TA 190/100 mmHg, FCC 100 b/min, infarct miocardic circular cu supradenivelare de segment ST. A fost revascularizat prin angioplastie în spital. Glicemia la 2 ore TOTG 10,2 mmol/l, DAM 3,9 µM/l, hs-PCR 11,2 mg/l. Externat în stare relativ satisfăcătoare. A decedat peste 14 luni prin infarct miocardic repetat. Patient S., 53 years old, hypertensive, overweight, smoker, was hospitalized with anginal pain, BP 190/100 mmHg, FCC 100 b/min, circular myocardial infarction with ST segment elevation. He was revascularized by angioplasty in the hospital. 2-hour blood glucose TOTG 10.2 mmol/l, DAM 3.9 µM/l, hs-PCR 11.2 mg/l. Discharged in relatively satisfactory condition. He died 14 months later from repeated myocardial infarction.

Exemplul 2 Example 2

Pacientul R., 42 ani, obez, fumător, a fost spitalizat cu dureri anginoase, TA 130/80 mmHg, FCC 92 b/min, infarct miocardic inferior cu supradenivelare de segment ST. A fost revascularizat prin tratament trombolitic în spital. Glicemia la 2 ore TOTG 10,0 mmol/l, DAM 3,85 µM/l, hs-PCR 10,0 mg/l. A decedat peste 20 luni prin infarct miocardic repetat. Patient R., 42 years old, obese, smoker, was hospitalized with anginal pain, BP 130/80 mmHg, FCC 92 b/min, inferior myocardial infarction with ST segment elevation. He was revascularized by thrombolytic treatment in the hospital. 2-hour blood glucose TOTG 10.0 mmol/l, DAM 3.85 µM/l, hs-PCR 10.0 mg/l. He died 20 months later from repeated myocardial infarction.

1. Tamita K., Katayama M., Takagi T., et al. Newly diagnosed glucose intolerance and prognosis after acute myocardial infarction: comparison of post-challenge versus fasting glucose concentrations. 2012, p. 98, 848-854 1. Tamita K., Katayama M., Takagi T., et al. Newly diagnosed glucose intolerance and prognosis after acute myocardial infarction: comparison of post-challenge versus fasting glucose concentrations. 2012, p. 98, 848-854

Claims

Method for predicting the risk of death in the acute post-myocardial infarction period, which consists in taking a blood sample from the patient, on the 10th day after admission, in which the concentration of C-reactive protein and malonic dialdehyde is determined, then, per os, a solution containing 75 g of glucose and 250 ml of water is administered, after which, after 120 min, another blood sample is taken, in which the blood sugar is determined and when the blood sugar is higher than 8.7 mmol/l, the concentration of C-reactive protein higher than 9.8 mg/l and the malonic dialdehyde higher than 3.51 µM/l, a high risk of death is predicted, if the blood sugar corresponds to the values 7.7…8.7 mmol/l, the concentration of C-reactive protein is 3.0…9.8 mg/l and the malonic dialdehyde of 1.9…3.51 µM/l - medium risk of death, and when blood sugar is less than 7.7 mmol/l, C-reactive protein concentration less than 3.0 mg/l and malonic dialdehyde less than 1.9 µM/l - a low risk of death.