O.B. Yaremenko, N.Kh. Iordanova, P.F. Dudka, T.M. Kuchmerovska. Possibility of differentiated approach to the usage of cardio protectors in patients with acute ST-elevation myocardial infarction taking into account the plasma amino acid spectrum.

The aim – to compare the effectiveness of a water soluble form of quercetin (corvitin) and 2-ethyl-6-methyl-3-hydroxypyridine succinate (mexicor), to estimate the dependence of a positive outcome effect of treatment on the baseline amino acid content of plasma (AACP) in pts with acute ST-elevation myocardial infarction (STEMI).

Material and methods. 116 pts with STEMI were prospectively examined and randomized into three groups: the group I and group II included the treatment by one of the metabolic cardio protectors (MC) (corvitin or mexicor) in addition to the basic therapy, the control group – only the basic therapy according to the clinical guidelines. The examination of pts included ECG, laboratory tests, echocardiography and AACP analysis on the first and tenth day of hospital period. The outcome treatment effect was measured as a minimal change of wall motion score index (ΔWMSI) by 0.0625. The decrease ΔWMSI by value ≥ 0.0625 was a criterion of positive outcome treatment effect.

Results. The usage of MC for pts with STEMI resulted in increase in viable mass of myocardium and decrease in WMSI in 61–71 % of pts (versus 38 % in pts without MC prescription). Non-responders in group I were characterized by significantly higher rate of complicated STEMI, such as persistent/late (on the third day and later) heart failure during the hospital period, compared with responders of group I and non-responders of group II. The results of multivariate logistic regression analysis and ROC-analysis demonstrated that baseline plasma phenylalanine/tyrosine ratio was an independent predictor of positive outcome effect of quercetin treatment (OR=0.30; Р=0.014). The sensitivity and specificity of baseline value of phenylalanine/tyrosine ratio ≤ 2.06 were 81.8 % and 71.4 % respectively. The baseline plasma homocysteine​/methionine ratio was an independent predictor of positive outcome effect of 2-ethyl-6-methyl-3-hydroxypiridine succinate treatment (OR=0.22; Р=0.002). The sensitivity and specificity of baseline value of homocysteine /methionine ratio ≤ 0.33 were 77.3 % and 77.8 % respectively.

Conclusions. The efficacy of MC largely depends on baseline AACP parameters involved in metabolic action of drugs. The positive effect of quercetin treatment is associated with the lower baseline plasma phenylalanine/tyrosine ratio (≤ 2,1), as well as for 2-ethyl-6-methyl-3-hydroxypiridine succinate effect the most important is lower ratio homocysteine /methionine (≤ 0.33).

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