The thesis is devoted to the improvement of the diagnosis and forecasting of the course of acute ST-elevation myocardial infarction (STEMI) in patients with overweight and obesity by studying key RF, features of clinical manifestations, lipid and carbohydrate metabolism, activity of systemic inflammation, leptin levels, biomarkers ST2 and NT-proBNP, echocardiography and coronaroangiography results, ultrastructural blood cells changes. It was found that the most common IHD RF was hypertension, although no significant difference between the studied groups was recorded (88.46±4.43 % (I), 92.16±3.76 % (II), 94.55± 3.06 % (ІІІ), p>0.05). The ratio of subjects with dyslipidemia was significantly higher among patients of group ІІІ compared with the subjects of group І (76.36±5.79 % versus 50.00±6.93 %) (р1-3=0.005). The ratio of patients with type 2 diabetes was also significantly higher in patients of group ІІІ compared with subjects of group I (47.27±6.73 % vs. 17.31±5.25 %) (р1-3=0.001). The acute left ventricle (LV) aneurysm, the development of acute heart failure (HF) (Killip klass III-IV) and rhythm and conduction disturbances were the most frequent complications of the early postinfarction period in STEMI patients. It has been proven that smoking significantly increases the relative risk of an acute LV aneurysm: in normal weight patients (group I) by 1.25 times, in subjects with overweight (group ІІ) – by 1.33 times, and in obese patients (group ІІІ) – by up to 6.56 times. It was found that late hospitalization (after 12 hours from the beginning of the disease) increases the most (by 3.33 times) the relative risk of an acute LV aneurysm in normal weight patients, compared with subjects with overweight (by 1.73 times) and obese patients (by 1.52 times). The relative risk of developing Killip class III-IV acute HF in the presence of the positive family history in the IHD development increases the most in the patients with overweight (by 53%), compared with normal weight subjects (by 22%) and obese patients (by 33%). Significant direct correlation of moderate strength was found between ST2 and NT-proBNP levels in STEMI patients upon admission to the hospital (r=0.325; p=0.011). Significant direct correlation of moderate strength was also found between these indicators when they were re-determined on the 10th day of hospital stay (r=0.454; p<0.001). Obese subjects significantly predominated among patients with complications (p=0.02). It was found that the risk of complications increases by 92 % in patients of group I when the NT-proBNP level exceeds the normal value during hospitalization (RR=1.92 [1.32; 2.80], p=0.035). It was also found that the risk of complications increases by 50% (RR=1.50 [1.08; 2.15], p=0.02) in patients of group III, when the NT-proBNP level exceeds the normal value on the 10th day of inpatient treatment. It was found that in patients of group III, when the ST2 indicator exceeds the normal value during hospitalization, the risk of acute HF (Killip klass III-IV) increases by 21% (RR=1.21 [1.10; 1.51], p=0,04), and when the standard value of ST2 indicator exceeds on the 10th day of inpatient treatment, this risk increases by 88 % (RR=1.88 [1.07; 5.05], p=0.02). The scientific data was supplemented that, according to the results of the Echocardiogram study, in STEMI patients in the presence of overweight and obesity, the signs of remodeling of the heart cavities are significantly more pronounced, which is accompanied by an increase in the degree of acute HF (p<0.05). It was established for the first time that changes in the level of NT-proBNP in STEMI patients in the early post-infarction period can diagnose a hidden variant of acute HF, and the levels of ST2 indicate the activity of myocardial remodeling and fibrosis processes. For the first time, independent predictors of the occurrence of complications in the early post-infarction period were established and a model was formed to predict the number of complications in patients with STEMI depending on risk factors, such as BMI, glucose, hospitalization after 12 hours from the onset of the disease, CRP and leptin. Scientific data on the prognostic value of NT-proBNP and ST2 indicators in patients with STEMI and abdominal obesity in the early post-infarction period was supplemented. Elevated levels of NT-proBNP and ST2 during hospitalization indicate a high risk of developing such complications as acute LV aneurysm, acute HF, heart rhythm and conduction disturbances, and MI recurrence. Scientific data on smoking as a universal RF for complications in patients with STEMI was supplemented. For the first time, it was established that it is the most important for obese people (p<0.05).
