Biomarkers of adverse outcomes of acute coronary syndrome with ST segment elevation in patients with metabolic disorders

Approximately 20% of patients develop various complications within the first year after myocardial infarction, including coronary artery restenosis, ischemic stroke, fatal arrhythmias, heart failure and/or cardiac death. Components of metabolic syndrome are recognized as risk factors for cardiovascular disease, but their role is more significant in the development of primary myocardial infarction. There is a need to search for biomarkers to predict the unfavorable clinical outcomes of acute coronary syndrome (ACS). The study of vitamin D metabolism, fibrinolysis system proteins and levels of cardiac-specific microRNAs 21, 29, and 143 appears to be promising as such predictors.

Aim: To identify the association of adverse outcomes within one year after myocardial infarction and vitamin D metabolism parameters, levels of fibrinolytic system components, and cardiac-specific microRNAs in patients with metabolic syndrome.

Material and Methods. The study included 152 patients initially hospitalized in a vascular center with a preliminary diagnosis of “ST-segment elevation ACS”. All patients underwent routine examination according to the standards for the management of patients with acute coronary syndrome. Adverse clinical outcomes were defined as recurrent ACS, arrhythmia and conduction disorders, left ventricular aneurysm, ischemic stroke, and death within 3 months after ACS. Depending on the presence of metabolic syndrome (MS), all patients were divided into two groups: group 1 – 94 patients with verified signs of MS; group 2 – 58 patients without MS. All patients underwent testing for vitamin D concentration; genetic variants of vitamin D receptor and vitamin D-binding protein polymorphisms; concentrations of urokinase and soluble urokinase receptor; and microRNAs-21, -29, and -143.

Results. Compared to group 2, group 1 had higher average levels of urokinase, soluble urokinase receptor, microRNA-29 and microRNA-143; lower average levels of 25(OH)D, and a higher frequency of the VDBP rs4588 C/A genotype; these differences were statistically significant. A correlation was found between adverse clinical outcomes in group 1 and microRNA-29 (r = 0.472, p < 0.0001), LDL levels (r = 0.234, p = 0.001), soluble urokinase receptor (r = 0.542, p < 0.0001), the presence of diabetes mellitus (p < 0.0001), and vitamin D-binding protein VDBP rs4588 polymorphism with genotype AA (p = 0.0011).

Conclusion. Potential biomarkers for the development of adverse clinical outcomes of acute coronary syndrome in patients with metabolic disorders were: the presence of diabetes mellitus, microRNA-29 levels and soluble urokinase receptor levels.

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