Evaluation of Procalcitonin Levels in Patients with Various Forms of Acute Coronary Syndrome, Depending on the Presence of Adverse Hospital Outcomes

Aim. to study the levels of procalcitonin in patients with various forms of acute coronary syndrome (ACS), depending on the presence of adverse hospital outcomes.

Materials and Methods. The study included 222 patients admitted to the emergency cardiology department with a diagnosis of ACS in the period from March 2014. until January 2017. Of these, 106 (47.7 %) patients were diagnosed with unstable angina (NS) and 116 (52.3%) with myocardial infarction (MI). Non ST segment elevation MI (NSTEMI) was diagnosed in 47 (40.5%) patients with MI, and ST elevation MI (STEMI) – in 69 (59.5%) patients with MI. After the assessment of the patient's compliance with the criteria for inclusion/exclusion in the study, the procedure for signing the patient's informed consent form was carried out. The protocol of the study was approved by the local Ethics committee of the M. E. Zhadkevich State Clinical Hospital. In each study subgroup, the presence of adverse outcomes during the current hospitalization was assessed: cardiovascular death, nonfatal MI, nonfatal acute cerebrovascular accident, acute heart failure, as well as a combined endpoint, including all of the listed adverse outcomes. All patients, in addition to routine laboratory methods of investigation, were examined for the level of procalcitonin at admission to the hospital, on 2-3 and 4-5 days.

Results. Patients with MI compared to patients with NS were characterized by a large number of registered endpoints in general (24.1% vs. 6.6%, p<0.001), while in the group of patients with MI, cardiovascular death was more often recorded (10.3% vs. 0.9%, p<0.001) and acute heart failure (12.9% vs. 5.6%, p=0.009). Patients with MI, in particular with STEMI, who had adverse hospital outcomes, were characterized by statistically significantly higher levels of procalcitonin compared to patients without adverse hospital outcomes. Patients with STEMI showed significantly higher levels of procalcitonin at all stages of the disease, and patients with MI-only at 2-3 and 4-5 days. There were no statistically significant differences in the level of procalcitonin at all stages of the disease in patients with NSTEMI and with unstable angina, depending on the hospital outcomes.

Conclusion. Elevated procalcitonin levels in patients with MI, in particular with STEMI, are associated with adverse hospital outcomes; for other forms of ACS, no statistically significant differences were observed with different hospital outcomes.

1. Drapkina OM, Samorodskaya IV, Starinskaya MA, et al. Comparison of Russian regions by the level of standardized mortality rates from all causes and diseases of the circulatory system in 2006-2016 Preventive Medicine. 2018;21(4):4-12 (In Russ.) DOI:10.17116/profmed20182144.

2. Shvec DA, Karasev AYu, Smolyakov MV, et al. Neural network analysis of predictors of lethal risk in patients after acute coronary syndrome. Russian Journal of Cardiology. 2020;3:68-75 (in Russ.) DOI:10.15829/1560-4071-2020-3-3645.

3. Boytsov SA, Demkina AE, Oshchepkova EV, et al. Achievements and problems of practical cardiology in Russia at the present stage. Kardiologiia. 2019;59(3):53-9 (In Russ.) DOI:10.18087/cardio.2019.3.10242.

4. Mit'kovskaya NP, Laskina OV, Tifi P. Unstable angina or unstable coronary syndromes? Emergency Cardiology and Cardiovascular Risks. 2020;4(1):816-849 (in Russ.)

5. Petrova OV, Tarasov DG, Nikulina DM. The importance of procalcitonin in cardiac surgery. Clinical and Experimental Surgery. 2018;6(1):51-61 (In Russ.) DOI:10.24411/2308-1198-2018-00008.

6. Mit'kovskaya NP. Cardiogenic shock in acute myocardial infarction-losses and achievements. Emergency Cardiology and Cardiovascular Risks. 2017;1(1):6-20 (In Russ.)

7. Mit'kovskaya NP, Abel'skaya IS, Postoyalko AS, et al. Acute ST-segment elevation coronary syndrome in patients at high risk of recurrent coronary events. Cardiology in Belarus. 2013;6(31):10-22 (In Russ.)

8. Marcevich SYu, Zagrebel'nyj AV, Zolotareva NP, et al. Register of acute coronary syndrome LIS-3: dynamics of clinical and demographic characteristics and tactics of pre-hospital and hospital treatment of survivors of acute coronary syndrome over a 4-year period. Rational Pharmacotherapy in Cardiology. 2020;16(2):266-72 (In Russ.) DOI:10.20996/1819-6446-2020-04-15.

9. Markova IA, Medvedeva EA, Gelis LG. Predicting the risk of recurrent coronary events in individuals with unstable angina in the long-term follow-up. Russian Journal of Cardiology. 2013;5(103):18-22 (In Russ.) DOI:10.15829/1560-4071-2013-5-18-22.

10. Kryuchkov DV, Heraskov VYu, Maksimov SA, et al. Some medical and social factors of the probability of hospital mortality in myocardial infarction. Bulletin of the Russian Academy of Medical Sciences. 2013; 68(11):30-3 (In Russ.)

11. Malaj LN, Davidovich IM, Solohina LV, et al. Khabarovsk Register of acute myocardial infarction: treatment and outcomes during the stay in the regional vascular center. Far Eastern Medical Journal. 2017;(1):6-10 (In Russ.)

12. Marcevich SYu, Ginzburg ML, Kutishenko NP, et al. Lyubertsy study on the mortality of patients with acute myocardial infarction. The first results of the "LIS" study. Clinician. 2011;(1):24-8 (In Russ.) DOI:10.17650/1818-8338-2011-1-24-27.

13. Soldatova OV, Kubyshkin AV, Ushakov AV, et al. Dynamics of the level of proinflammatory cytokines in various variants of the course of acute myocardial infarction. Bulletin of Siberian Medicine. 2017;16(1):92-100 (In Russ.) DOI:10.20538/1682-0363-2017-1-92-100.

14. Ponasenko AV, Hutornaya MV, Golovkin AS, et al. Procalcitonin and interleukin 1β as markers of the course of the postoperative period in patients with prosthetic heart valves. Basic Research. 2014;(4-3):589-92 (In Russ.)

15. Sharma YP, Kasinadhuni G, Santosh K, et al. Prognostic role of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock. Asian Cardiovasc Thorac Ann. 2021 Jan 14;218492320987918. DOI:10.1177/0218492320987918.

16. Reindl M, Tiller C, Holzknecht M, et al. Association of Myocardial Injury With Serum Procalcitonin Levels in Patients With ST-Elevation Myocardial Infarction. JAMA Netw Open. 2020;3(6):e207030. DOI:10.1001/jamanetworkopen.2020.7030.

17. Dai J, Xia B, Wu X. Elevated plasma procalcitonin level predicts poor prognosis of ST elevation myocardial infarction in Asian elderly. Scand J Clin Lab Invest. 2018;78(1-2):49-54. DOI:10.1080/00365513.2017.1408141.