జీవశాస్త్రం మరియు వైద్యం

నైరూప్య

Evaluation of Long-Term Changes in the Levels of Inflammatory Factors during Postoperative Period in Patients with Acute Coronary Syndrome without STSegment Elevation Undergone Coronary Artery Bypass Surgery

Natalia Gavrisheva, Korzhenevskaya K, Alekseeva G, Boyko A and Panov A

Objective: One of the most effective and widely used methods of myocardial revascularization in patients with acute coronary syndromes is coronary artery bypass surgery (CABG). Chronic inflammation plays a significant role in the destabilization of atherosclerotic plaques in acute forms of ischemic heart disease and also in relapse of myocardial ischemia after myocardial revascularization. Ischemic myocardial injury is associated with activation of molecular and cellular inflammatory factors, the most important of which are cytokines, cell adhesion molecules (CAM) and leukocytes. Changing in the concentration of these agents during postoperative period reflects the intensity of the inflammatory and reparative processes in the myocardium. In this context, it is relevant to evaluate the long-term dynamics of inflammatory markers in the patients undergone coronary artery bypass grafting to predict the possible exacerbation of coronary heart disease. Methods: The study involved 130 patients who underwent CABG surgery with acute coronary syndrome without ST-segment elevation. The comparison group consisted of 28 patients who suffered from stable coronary artery disease (average age 50.9 ± 1.2 years) with a history of MI, no earlier than 6 months prior to study entry. The levels of serum inflammatory markers (ICAM-1, TNF-α, IL-6, leukocytes) were measured before operation and 6.12, 24 and 48 months after CABG. Results: The study showed that soluble intercellular adhesion molecule-1 (ICAM-1) and leukocyte levels in patients with non-ST elevation acute coronary syndrome gradually decreased during follow-up period in comparison with preoperative rates. sICAM-1 level increased up to 48 month and tended to preoperative value. There were no changes in tumor necrosis factor- alpha (TNF-α) and interleukin-6 (IL-6) levels during the whole follow-up period. TNF-α level in the patients with NSTE ACS before surgery have not differed from the level in the patients with stable ischemic heart disease (62.0 ± 9.8 pg/ml and 51.0 ± 6.8 pg/ml; p>0.05). TNF-α serum level has remained unchanged in the patients after CABG. Preoperative levels of IL-6 did not differ significantly among the patients with NSTE ACS and stable coronary artery disease (34.5 ± 3.6 pg/ml and 28.6 ±3.1 pg/ml; p>0.05). The IL-6 levels remained practically unchanged over time. Conclusion: According to the results we can suggest, that further maintenance and development of the inflammatory process after CABG will contribute to the progression of coronary heart disease preserving the risk of exacerbation and reocclusion of coronary blood vessels.