Prognosis of development of complications of cardiogenic shock and pulmonary edema in patients with myocardial infarction on background of obstructive pulmonary disease

Abstract

Objective. To create a personalized mathematical model of the development of complications – cardiogenic shock and pulmonary edema in patients with myocardial infarction (MI) with chronic obstructive pulmonary disease (COPD) depending of the homocysteine (HCY) level and the COPD phenotype.Materials and methods. The study included 88 patients with MI and COPD with various phenotypes: 25 patients with emphysematous phenotype, 22 patients with a mixed phenotype, 20 patients with chronic bronchitis phenotype, 21 patients with eosinophilia and bronchial asthma (BA). As a control group, 50 somatically healthy individuals were examined. Gender anamnestic, clinical, and laboratory – instrumental indicators were studied and analyzed to develop a predictive mathematical model. The level of HCY was determined by enzyme-linked immunosorbent assay in all patients.Results. It was found that in patients with MI and COPD with different COPD phenotypes, the level of HCY was statistically significantly higher than in the control group. The highest level of HCY was in patients with the chronic bronchitis phenotype and was 45 [14.1; 51.9] mmol/l, which was statistically significantly higher than in patients with the phenotype with eosinophilia and BA, with emphysematous and mixed phenotypes. Predictor factors were selected using the logit regression method from gender-anamnestic, clinical, and laboratory – instrumental indicators to create a mathematical model with the highest prediction accuracy. HCY level and COPD phenotype were predictors of the mathematical model for predicting the development of complications – cardiogenic shock and pulmonary edema in patients with MI and COPD. It was also found that the threshold value of HCY for predicting the development of cardiogenic shock and pulmonary edema in patients with MI and COPD was 0.82 ± 0.51 confidence interval [0.72–0.91] mmol/l (p < 0.001).Conclusion. The personalized mathematical model initiated for predicting the development of complications-cardiogenic shock and pulmonary edema in patients with MI and COPD, depending of the HCY level and the COPD phenotype, has a high sensitivity (85%) and prognostic significance (92%), which allows us to recommend it for use in clinical practice.