Myocardial ischemia-reperfusion injury in patients with unstable angina and coronary stenting

Objective. To study frequency and identify predictors of myocardial ischemia-reperfusion injury in patients with unstable angina and stenting of the coronary arteries.
Materials and Methods. The study included 61 patients with unstable angina and coronary artery stenting. Stenting was performed 3.2±1.4 days after admission to the hospital. The average number of affected vessels was 1.76±0.3 per person, the average number of implanted stents was 1.9±1.32 per person.
The risk according to the GRACE scale at the time of stenting was 100.3±8.46 points. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein levels; platelet, plasma and vascular hemostasis were evaluated. Patients also underwent echocardiography and coronary angiography.
Results. According to MRI with gadolinium, in 31% of patients with unstable angina after coronary artery stenting, ischemia-reperfusion injury of the myocardium in the form of edema was registered. According to coronary angiography, perfusion disorders were detected in 9.4% of all patients, and 31.5% of patients with MRI picture of myocardial edema. In the group of patients with reperfusion injury, it was found that ECG criteria for ischemia-reperfusion injury were registered in 68.4% of patients, ST-segment changes during 24-hour ECG monitoring were revealed in 21% of patients. The presence of angiographic signs of atherosclerotic plaque instability was accompanied by the development of myocardial edema according to MRI (χ2 = 28.515, RR 2.7, p = 0.000, 95% CI 1.724-4.365).
The presence of myocardial edema after coronary artery stenting in patients with unstable angina may be a marker of persistent postischemic myocardial dysfunction and is associated with pathological myocardial remodeling processes.
Conclusion. The developed model for predicting ischemia-reperfusion injury included the baseline level of myeloperoxidase and ECG changes on the first day after stenting. The overall percentage of correct predictions was 83.6%.

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