PREDICTORS OF LIFE-THREATENING COMPLICATIONS (CARDIOGENIC SHOCK AND PULMONARY EDEMA) IN THE ACUTE PERIOD OF MYOCARDIAL INFARCTION IN PATIENTS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA SYNDROME

Sultanova Oksana Esedullayevna, Chernysheva Elena Nikolaevna, Popov Evgeny Antonovich, Prokopenko Nadezhda Andreevna, Pechorov Alexander Andreevich, Kasatkina Svetlana Grigorievna, Sultanova Samira Shamilevna

Objective: To determine the prognostic significance of plasma homocysteine (Hcy) and magnesium (Mg) levels for assessing the risk of life-threatening complications (cardiogenic shock and pulmonary edema) in the acute period of myocardial infarction in patients with undifferentiated connective tissue dysplasia syndrome (UCTDS). Materials and methods: The study included 113 patients with a confirmed diagnosis of acute coronary syndrome (ACS) against the background of UCTDS, who were treated in the Regional Vascular Center of Astrakhan in the period 2019–2025. All patients underwent determination of Hcy and Mg levels in blood serum on the 1st day of hospitalization. The development of cardiogenic shock and/or pulmonary edema within the first 7 days from the onset of ACS was considered as endpoints. Statistical data processing was performed using STATISTICA 12.0 software. ROC analysis with calculation of the area under the curve (AUC), sensitivity and specificity was used to assess the prognostic significance of the indicators. Results: The development of life-threatening complications was observed in 44 (38.9%) patients. Statistically significant differences in Hcy and Mg levels were found between the groups with complicated and uncomplicated course. Based on ROC analysis, threshold values were determined: Hcy level > 29.25 μmol/l (AUC=0.846; sensitivity 95.7%, specificity 77.6%) and Mg level < 0.59 mmol/l (AUC=0.927; sensitivity 97.7%, specificity 76.8%) are highly informative predictors of life-threatening complications. The prognostic model developed on the basis of logistic regression (χ²=86.373; p<0.001) demonstrated high diagnostic efficiency (92.0%). Conclusion: Determination of homocysteine and magnesium levels in blood serum on the 1st day of ACS in patients with UCTDS allows for high-accuracy risk stratification for the development of cardiogenic shock and pulmonary edema. The identified threshold values can be used in clinical practice to form high-risk groups and timely intensify therapy.

Keywords:acute coronary syndrome, myocardial infarction, connective tissue dysplasia, homocysteine, magnesium, cardiogenic shock, pulmonary edema, prognosis.