The dissertation proposes optimization of detection and treatment of patients with renal dysfunction and ST segment elevation acute myocardial infarction (STEMI) without signs of acute left ventricular failure by Killip and previously known kidney disease. The urgency of the problem is due to the clinical course and the prognosis of STEMI, where kidney dysfunction plays an important role. The main criteria for inclusion in the study were: STEMI, hospitalization within the first 12 hours of disease onset, known creatinine at day 1 and within 7 days of hospitalization. The following exclusion criteria were used: previously known kidney disease, GFR less than 45 ml/min/1,73m2 in the first day of STEMI, acute heart failure III-IV Killip class, chronic heart failure IIB-III stage, uncontrolled hypertension, severe comorbidity. At the first stage of the work, a retrospective analysis of the database of patients with STEMI was conducted. Depending on GFR at the time of hospitalization, 2 groups of patients were formed: IA group - 335 people with reduced GFR 45-89 ml/min/1,73m2, IB group - 132 with normal GFR>=90 ml/min/1,73m2. Depending on the dynamics of GFR for 7 days of the hospital period, regardless of baseline GFR for 1 day of STEMI, all patients were divided into additional 2 groups. The group IIA included 98 patients with GFR reduction by 20% or more during the 7 days of the hospital period; the group IIB consisted of 369 patients without GFR reduction. In the second stage of work, 122 patients were examined. All patients were divided into 3 groups: 1 group - GFR>=90 ml/min/1,73m2; Group 2 - GFR 60-89 ml/min/1,73m2; Group 3 - GFR 45-59 ml/min/1,73m2. Each of three groups was also divided into 2 subgroups using a GFR reduction rate of 20% or more over a 7-day hospital period. In 32 patients and 10 patients who did not have coronary heart disease, the level of cardiospecific miRNAs was determined. These patients were also divided into 2 groups: group 1 - 20 patients receiving standard therapy plus water soluble quercetin, group 2 - 12 patients receiving standard therapy only. 2 patient groups (1:1 ratio) - 24 pairs were selected from the patient base used in the first stage of the work with the help of an automated match-control algorithm. Patients in the first group received an injectable form of quercetin. Twenty-four patients in the second group who did not receive quercetin formed a control group receiving standard therapy only. Reduced initial GFR level in stable patients with STEMI did not affect the long-term prognosis, unlike deterioration of renal function (reduction of GFR by 20% or more), which was associated with more than twofold increase in the number of cardiovascular death cases combined endpoint (cardiovascular death and acute coronary syndrome) over 3 years of follow-up. In STEMI patients there is a low increase in the diameter of the brachial artery when conducting a test with endothelium-dependent vasodilation on the first day, indicating the initial disorders of endothelial function with subsequent improvement on the background of modern treatment. However, impaired renal function is characterized by more pronounced endothelial dysfunction and its persistence over 7 days of follow-up regardless of baseline GFR. Potential clinical significance of increased levels of miR-155 in mononuclear cells, which acts as a nephroprotective factor, was shown. It was found that the frequency of detection of renal dysfunction in the group of patients with STEMI on the background of treatment with injectable water-soluble quercetin was significantly lower than in the control group (4,2% vs. 33,3%, P<0,05). The scientific novelty is that for the first time the potential clinical significance of determining the increased level of mononuclear miR-155 in early diagnosis of myocardial lesions in STEMI was proved, the peculiarities of the clinical course of hospital and post-hospital periods, laboratory and instrumental parameters in patients with impaired renal function were studied. Effectiveness of water-soluble quercetin therapy in patients with STEMI and renal dysfunction was evaluated.
