Title
Prognostički značaj sistemskog inflamatornog odgovora kod bolesnika sa dijabetes melitusom tip 2 i akutnim infarktom miokarda sa elevacijom ST-segmenta koji su lečeni primarnom perkutanom koronarnom intervencijom
Creator
Milić, Veljko M. 1965-
Copyright date
2018
Object Links
Select license
Autorstvo-Nekomercijalno-Bez prerade 3.0 Srbija (CC BY-NC-ND 3.0)
License description
Dozvoljavate samo preuzimanje i distribuciju dela, ako/dok se pravilno naznačava ime autora, bez ikakvih promena dela i bez prava komercijalnog korišćenja dela. Ova licenca je najstroža CC licenca. Osnovni opis Licence: http://creativecommons.org/licenses/by-nc-nd/3.0/rs/deed.sr_LATN. Sadržaj ugovora u celini: http://creativecommons.org/licenses/by-nc-nd/3.0/rs/legalcode.sr-Latn
Language
Serbian
Cobiss-ID
Theses Type
Doktorska disertacija
description
Datum odbrane: 06.03.2018.
Other responsibilities
mentor
Pavlović, Milan
predsednik komisije
Deljanin Ilić, Marina
član komisije
Obradović, Slobodan
član komisije
Antić, Slobodan
član komisije
Dragović, Tamara
Academic Expertise
Medicinske nauke
University
Univerzitet u Nišu
Faculty
Medicinski fakultet
Group
Katedra za internu medicinu
Alternative title
Prognostic importance of systemic inflammatory response in patient with type 2 diabetes mellitus and ST segment elevation myocardial infarction who undergo to primary percutaneous coronary intervention.
Publisher
[V. M. Milić]
Format
VI, 88 listova
description
Biografija: list 88;
Bibliografija: listovi 63-87
description
CARDIOLOGY
Abstract (en)
INTRODUCTION: inflammation is associated with acute myocardial infarction and plays a key role in wound healing and scar formation. C-reactive protein and fibrinogen (CRP), acute phase inflammation phases are an accessible marker and are used in everyday clinical practice. The role of these biomarkers as prognostic factors for devel-oping heart failure and mortality on the acute myocardial infarction has already been investigated. Diabetes has long been known to be a risk factor for cardiovascular disease and is also associated with in-flammation. Patients experiencing myocardial infarction with eleva-tion of the ST segment (STEMI) undergo percutaneous coronary in-tervention (PKI), which itself is associated with an increased inflam-matory response. However, the difference in the inflammatory re-sponse between patients with and without diabetes who undergoes primary PKI is still not completely clear.
METHODOLOGY: A total of 475 consecutive patients with the first myocardial infarction, with and without diabetes, were subjected to primary PKI. C-reactive protein and fibrinogen sui from the patient's blood determined in the first 48 h and the maximum value was taken. A comparative analysis of coronary angiograms of both groups of pa-tients was performed and CRP and fibrinogen were examined as a prognostic factor for the primary and secondary study objectives. The primary goals are: hospital death, hospital coronary death, hospital reinfarction and mortality for all reasons for six months. Secondary goals are: composite outcome (coronary death, periprocedural cere-brovascular event, reinfark and repeated revascularization), systolic and diastolic left ventricular dysfunction discharge. The analysis of variance examined the importance of CRP and fibrinogen as a marker for future adverse events.
RESULTS: Of the 475 patients with the first STEMI, 127 (26.7%) were diabetic patients and 348 (73.3%) were without diabetes. Pa-tients with diabetes have a significantly higher value of CRP and fi-brinogen compared to patients without diabetes [29.6 (10.4-91.8) ac-cording to 22.4 (9.79-49.2), p = 0.046 and 4.7 (3.6-6.3) to 4.3 (3.6-5.4), p = 0.026]. However, a multivariate analysis using the Cox re-gression model shows that in patients without diabetes CRP and fi-brinogen are independent prognostic biomarkers for hospital mortality [HR 1,013 95% CI (1,004-1,022), p = 0,004; HR 1,529 (1.023-2.287), p = 0.039]. In terms of six-month mortality, only CRP, not fibrinogen, showed a borderline prognostic significance [HR 1,013 95% CI
(1,000-1,027), p = 0,048]. Total survival is lowest in the fourth quar-tile of CRP in patients without diabetes.
CONCLUSION: elevated CRP values are a significant prognostic fac-tor for hospital and six-month mortality in patients without diabetes with the first STEMIs treated with primary PKI, but not for patients with diabetes. The lowest survival in the group without diabetes is in the fourth quartile of CRP. Fibrinogen can be used as an additional prognostic biomarker for hospital mortality.
Authors Key words
CRP, fibrinogen, diabetes, STEMI, prognoza, mortalitet
Authors Key words
CRP, fibrinogen, diabetes, STEMI, prediction, mortality
Classification
616.127-005.8-089.819.5-036:616.379-008.64(043.3)
Subject
B530
Type
Elektronska teza
Abstract (en)
INTRODUCTION: inflammation is associated with acute myocardial infarction and plays a key role in wound healing and scar formation. C-reactive protein and fibrinogen (CRP), acute phase inflammation phases are an accessible marker and are used in everyday clinical practice. The role of these biomarkers as prognostic factors for devel-oping heart failure and mortality on the acute myocardial infarction has already been investigated. Diabetes has long been known to be a risk factor for cardiovascular disease and is also associated with in-flammation. Patients experiencing myocardial infarction with eleva-tion of the ST segment (STEMI) undergo percutaneous coronary in-tervention (PKI), which itself is associated with an increased inflam-matory response. However, the difference in the inflammatory re-sponse between patients with and without diabetes who undergoes primary PKI is still not completely clear.
METHODOLOGY: A total of 475 consecutive patients with the first myocardial infarction, with and without diabetes, were subjected to primary PKI. C-reactive protein and fibrinogen sui from the patient's blood determined in the first 48 h and the maximum value was taken. A comparative analysis of coronary angiograms of both groups of pa-tients was performed and CRP and fibrinogen were examined as a prognostic factor for the primary and secondary study objectives. The primary goals are: hospital death, hospital coronary death, hospital reinfarction and mortality for all reasons for six months. Secondary goals are: composite outcome (coronary death, periprocedural cere-brovascular event, reinfark and repeated revascularization), systolic and diastolic left ventricular dysfunction discharge. The analysis of variance examined the importance of CRP and fibrinogen as a marker for future adverse events.
RESULTS: Of the 475 patients with the first STEMI, 127 (26.7%) were diabetic patients and 348 (73.3%) were without diabetes. Pa-tients with diabetes have a significantly higher value of CRP and fi-brinogen compared to patients without diabetes [29.6 (10.4-91.8) ac-cording to 22.4 (9.79-49.2), p = 0.046 and 4.7 (3.6-6.3) to 4.3 (3.6-5.4), p = 0.026]. However, a multivariate analysis using the Cox re-gression model shows that in patients without diabetes CRP and fi-brinogen are independent prognostic biomarkers for hospital mortality [HR 1,013 95% CI (1,004-1,022), p = 0,004; HR 1,529 (1.023-2.287), p = 0.039]. In terms of six-month mortality, only CRP, not fibrinogen, showed a borderline prognostic significance [HR 1,013 95% CI
(1,000-1,027), p = 0,048]. Total survival is lowest in the fourth quar-tile of CRP in patients without diabetes.
CONCLUSION: elevated CRP values are a significant prognostic fac-tor for hospital and six-month mortality in patients without diabetes with the first STEMIs treated with primary PKI, but not for patients with diabetes. The lowest survival in the group without diabetes is in the fourth quartile of CRP. Fibrinogen can be used as an additional prognostic biomarker for hospital mortality.
“Data exchange” service offers individual users metadata transfer in several different formats. Citation formats are offered for transfers in texts as for the transfer into internet pages. Citation formats include permanent links that guarantee access to cited sources. For use are commonly structured metadata schemes : Dublin Core xml and ETUB-MS xml, local adaptation of international ETD-MS scheme intended for use in academic documents.