Tyravska Y. Clinical and hemostatic parameters and their dynamics during statins treatment in unstable angina patients

The study actuality is determined by the high frequency of unstable angina (UA) complications, comparabilityle with myocardial infarction (MI) without ST segment elevation and the need to improve the differential diagnosis of chest pain of ischemic and non-ischemic origin. New biomarkers of UA complications for its early personalized correction are highly needed. Consequently, it is reasonable to study the parameters of the hemostasis and fibrinolysis in view of their key role in the atherothrombosis. As the heterogeneity of pleiotropic effects of statins exists the optimal statin with the higest potential for hemostasis recovery should be revealed. The aim of the study is to improve the quality of clinical and laboratory diagnosis of UA and predict its course on the basis of determining the hemostasis parameters to compare the potential for hemostasis disorders recovery of atorvastatin and rosuvastatin. Objectives of the study: 1. To establish features of a hemostasis and fibrinolysis in UA clinical types. 2. To find out the relationships between hemostasis factors and clinical history, hemodynamic and electrocardiographic parameters in UA patients. 3. To develop models of indirect assessment of hemostasis parameters in UA patients based on the relationship with clinical history, hemodynamic and electrocardiographic parameters. 4. To determine the hemostasis factors as potential criteria for the chest pain differential diagnosis in ppatients with suspected UA 5. To analyze the hemostasis parameters as possible predictors of cardiovascular complications in UA. 6. To establish intragroup features of statins influence on hemostasis and myocardial ischemia in UA patients on the basis of the comparative analysis. We recruited 172 patients aged 60.32 ± 6.94 years, 59 women (34.3%) and 113 men (65.7%) examined and treated in the Kyiv City Clinical Hospital №12 cardiology department for the period 2017-2019, as well as 10 healthy volunteers of the control group (4 women (40.0%) and 6 men (60.0%). 83.5% (152 persons) were hospitalized with a preliminary diagnosis "ACS: unstable angina", and 20 (11.0 %) ‒ patients with stable angina (SS) with the urgency hospitalization. UA was confirmed in 110 patients, among them 40 patients with new-onset UA (NOUA), and 70 patients with progressive UA (PUA). 42 (27.6%) patients with chest pain of non-ischemic (vertebrogenic) origin were identified, in whom UA was not confirmed. During the 28-day follow-up period UA was transformed toward MI in 10 (9.1%) patients (7 NOUA patients and 3 PUA patients). To study intragroup statins effects on hemostasis comparable groups of PUA patients were treated with atorvastatin 60 mg/ day (26 patients) or rosuvastatin 20 mg/ day (24 patients). Thus, following the objectives the study design is based on several types of observational research, namely: - cross-sectional: A) patients with NOUA, PUA, SA (urgency hospitalization) and control (objectives 1-3); B) patients with suspected UA (objective 4); - cohort prospective: A) patients with UA, taking into account the development of complications (objective 5); B) PUA patients taking atorvastatin or rosuvastatin (objective 6).