Influence of revascularization strategy on systemic inflammation, renal function, and myocardial stress in STEMI patients with multivessel disease

The objective: to establish the relationship between the duration and extent of myocardial revascularization and the severity of the systemic inflammatory response, as well as to evaluate the impact of the acute inflammatory response on renal function and myocardial stress (assessed by N-terminal pro-B-type natriuretic peptide (NT-proBNP) level) as predictors of adverse cardiovascular events in patients with ST-segment Elevation Myocardial Infarction (STEMI).Materials and methods. A single-center observational study enrolled 120 patients with a verified diagnosis of STEMI and multivessel coronary artery disease. Patients were divided into two equal groups (n = 60): a group of complete revascularization (stenting of all hemodynamically significant lesions) and a group of incomplete revascularization (isolated reperfusion of the infarct-related artery only). Clinical and anamnestic data, duration of percutaneous coronary intervention, dynamics of inflammatory markers (leukocytes), indicators of renal function (creatinine), and myocardial stress (NT-proBNP) were evaluated.Results. In the incomplete revascularization group, a significantly higher frequency of previous acute cerebrovascular accidents was observed (16.39% vs 5.00%; p = 0.04). A significant direct correlation was found between the duration of the operation and the increase in blood leukocyte level (r = 0.26; p < 0.05). No statistical difference was found in the incidence of acute contrast-induced nephropathy between the complete (23%) and incomplete (26%) revascularization groups (p > 0.05). A strong correlation was established between the peak level of leukocytosis and the increase in creatinine (r = 0.55 in the complete revascularization group; p < 0.05). A direct correlation was revealed between the increase in leukocytes and NT-proBNP concentration (ρ = 0.244; p = 0.007). An early increase in NT-proBNP levels > 260.0 pg/mL is a reliable predictor of adverse clinical outcomes (AUC = 0.779).Conclusions. Prolongation of the operative procedure is associated with a weak but statistically significant increase in the intensity of the systemic inflammatory response in the first 48–72 hours. The presence of a direct correlation between peak leukocytosis and creatinine increase (r = 0.55 in the complete revascularization group; p < 0.05) suggests a significant role for systemic inflammation in the pathogenesis of acute kidney injury. Patients with pronounced leukocytosis demonstrate a significantly higher risk of further progression of heart failure (p = 0.0002), and NT-proBNP levels > 260.0 pg/mL serve as a reliable predictor of adverse clinical outcomes based on ROC analysis (AUC = 0.779).