Clinical and biochemical phenotypes in cardiorespiratory comorbidity

Abstract

   Objective: to estimate the incidence of recurrent myocardial infarction, stroke, and mortality in patients with different phenotypes of myocardial infarction against the background of chronic obstructive pulmonary disease.   Materials and methods: 325 patients with myocardial infarction were examined: 195 patients with infarction against the background of chronic obstructive pulmonary disease and 130 patients without chronic obstructive pulmonary disease. We studied markers of endogenous intoxication: molecules of average mass, hematological indexes of intoxication, blood gas composition, apoptosis, protein peroxidation, lipid and antioxidant protection, inflammation and renal function. Statistical processing of the data was performed using SPSS 26.0 software package.   Results: A two-stage cluster analysis formed four clusters, which were labeled as «polymarker-retentive», «necrotic-inflammatory», «hypoxic-inflammatory», and a cluster with no endogenous intoxication syndrome. Among patients with myocardial infarction against the background of chronic obstructive pulmonary disease, the hypoxic-inflammatory phenotype prevailed — in 53.3 % of patients. Necrotic-inflammatory phenotype was noted in 8.2 % of patients, hypoxic-inflammatory — in 36.9% of patients, phenotype with the absence of endogenous intoxication syndrome — in 1.5 % of patients. Recurrent myocardial infarction, stroke and mortality constituted the combined endpoint. The highest incidence of the combined endpoint was observed in the polymarker-retentive infarct phenotype — in 37 (55.2 %) patients.   Conclusion: Vascular life-threatening and fatal events (recurrent myocardial infarction, stroke, death from cardiac causes) during 12-month follow-up are most typical for the polymarker-retentive phenotype. The clinical features of this phenotype were the frequent presence of Q-shaped MI, transmural myocardial damage, and the presence of complications in the acute period. COPD in these patients was characterized by a long course, high smoker's index, mostly 3rd degree bronchoobstruction, and frequent exacerbations. The results of this study allow for a personalized approach to the assessment of the annual prognosis in patients with acute myocardial infarction against COPD.