The aim – to create a new method of assessing the development of hospital complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 317 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=214). Group 2 – 103 patients, who were studied prospectively. The group of patients did not differ in clinical and anamnestic characteristics and treatment. An index of hospital complications was created for assessing the criteria of the severity of the clinical course.Results and discussion. A number of correlation analyses were performed to examine the relationships between white blood components, platelet heterogeneity and systemic inflammation, and the hospital complication index. On the basis of these data we have built a complex index – leukocyte-platelet index (LTI): LTI (conditional unit) = ((GRA – MON) / LYM) · 10 + PDWc + P-LCR, where: GRA is the number of granulocytes in the blood test, MON is the number of monocytes, LYM is the number of lymphocytes, PDWc is the percentage of platelet distribution by size, and P-LCR is the percentage of large (> 12fL) platelets. When assessing in group 1 correlations with the index of nosocomial complications and combined indicators: neutrophil-lymphocyte ratio (NLR) and the LTI index created by us showed the highest degree of correlation with the index of hospital complications (р<0.001 and р<0.0005, respectively). When the value of LTI > 137 conventional units can be judged on the increased risk of nosocomial complications of AMI (sensitivity 64 %, specificity 78 %, area under the curve 0.72). Thus, in a prospective approbation study, the LTI on the first day of AMI was significantly (р<0.05) better than other indicators, in particular, better than the widely used leukocyte marker NLR in determining the susceptibility to the undesirable course of the hospital period of the disease.Conclusions. The created computer algorithm for calculating the risk index of complications in patients with AMI on the first day can be widely implemented in modern health care facilities in Ukraine.

The aim – to determine the extent of different subpopulations of blood monocytes in acute myocardial infarction (AMI) with ST-segment elevation patients on day 1 and 7 and to evaluate the relationship between their content and the dynamics of changes and the risk of complications after AMI.Materials and methods. The composition of individual subpopulations of monocytes in the peripheral venous blood (and general clinical and biochemical blood tests) was evaluated in 50 pts with STEMI (who were admitted within 6 hours after the onset of the disease) at admission (before primary PCI) and on day 7. All patients received standard recommended therapy. Dynamic heart echocardiography was also performed on the 1st and 7th day. All patients were divided into 2 groups depending on the dynamical increase (1 group – 21 pts) or decrease (2 group – 29 pts) of classical monocytes (CD14hiCD16–) subpopulation during 7 days of follow-up. The control group included 15 healthy subjects with no signs of coronary heart disease and 23 pts with chronic coronary heart disease without AMI.Results and discussion. In subgroup 1, the percentage of the «classical» fraction of monocytes during the observation increased to 89.0±1.2 %, which was 4.2 % more than on the 1st day and 12.5 % more than in the control group (р<0.05), while the absolute amount of classic monocytes on day 7 increased by 48 % compared to initial value (р<0.01). The percentage of «intermediate» (CD14hiCD16+) blood monocytes in patients of this subgroup on the 1st day of hospitalization was 70 % higher than in the control group, and 42 % higher than in the 2nd subgroup of patients (р<0,001), however, on the 7th day it decreased by 30 % compared to baseline, although it remained by 8 % more than in the control group (the absolute number of «intermediate» monocytes did not change). The activation index (IA) of the «intermediate» monocytes on the first day did not differ between subgroups and was 40 % higher than in the control group (р<0.001). However, in the dynamics of observation, in patients of subgroup 1, this figure did not change, while in subgroup 2 IA decreased by 60 % (р<0.001). Despite the fact that the absolute number of anti-inflammatory («patrolling») (CD14+lowCD16++) monocytes did not change until the 7th day of observation (and their percentage decreased slightly), their IA was significantly lower than in the control group (95 %) and in patients of subgroup 2 (92 %, р<0,001). In patients of subgroup 2, the decrease of the percentage of «classic» monocytes was –7.7 % (from 90.4±0.8 to 83.4±1.2 %). Despite the fact that the number and percentage of intermediate monocytes increased in dynamics, their IA decreased almost 2 times, which may indicate a decrease in the pro-inflammatory ability these monocytes. The percentage and number of «patrolling» monocytes increased in dynamics by 37.4 % (р<0.0001) and by 268.3 % (р<0.01), respectively. IA of patrolling monocytes was almost 12 and 7 times higher than in patients of subgroup 1 on the 1st and 7th day of observation, respectively, which may indicate a significant activation of anti-inflammatory activity of patrolling monocytes. Intracardiac thrombosis was 3.3 times more common in patients of subgroup 1, in this subgroup was also more often noted (compared to the subgroup 2): dilatation of the left ventricle (almost 8 times), reduction of left ventricular ejection fraction (4 times), and pathological post-infarction remodeling of the left ventricle (almost 7 times).Conclusions. The results of the study indicate the important role of different subpopulations of blood monocytes in the processes of myocardial damage and recovery (in particular, the pro-inflammatory role of increasing the number of classical monocytes and increasing the activity of intermediate monocytes, as well as the anti-inflammatory role of increasing the number, percentage and activity of patrolling monocytes) in patients with AMI and can be the basis for developing new approaches to the diagnosis and prevention of complications of this disease.

Aims Acute myocardial infarction with the ST elevation (STEMI) is accompanied by the development of an inflammatory reaction, in particular, activation of monocytes. To date, the relationship between the levels and dynamics of monocyte populations in patients with STEMI and the prevalence of coronary atherosclerosis on the one hand (and with the clinical course of the disease, on the other hand) is not well understood. Methods and results The 50 STEMI patients (pts) were studied prospectively. All the pts underwent the PCI (alone, or followed by angioplasty/stenting) and have the monocytes (Mc) population analysis data obtained at 1st and 7th–10th days. According to the angiography data, pts were divided into three groups: “single-vessel lesion” (group 1, n=13), “two-vessel lesion” (group 2, n=14) and “three-vessel lesion” (group 3, n=23). There was an in-hospital increase in CD14++CD16-, CD14++CD16+ and CD14+CD16++ populations of Mc in 3rd group (+5%, +43% and +44%, respectively, p&lt;0.05 for all), whereas in subgroups 1 and 2 there was an increase in CD14+CD16++ population (+70% in group 1, p&lt;0.05 and +90% in group 2, p&lt;0.001), without significant dynamics of CD14++CD16− and CD14++CD16+ populations. In addition, there was an increase in the CD14+CD16++ population only in pts with 1–3 coronary lesions (+72%, p&lt;0.001 versus −12% of decrease in pts with more than 3 lesions, p&gt;0.1). The number of CD14++CD16+ Mc on day 1 of STEMI correlated positively with levels of C-reactive protein (C-RP, r=0.34, p&lt;0.05), erythrocyte sedimentation rate (ESR, r=0.39, p&lt;0.01), and with left ventricle (LV) end-systolic volume (r=0.33, p&lt;0.05) and negatively – with LV ejection fraction (r=−0.22, p&lt;0.1), while there were only slight correlations of CD14++CD16- Mc levels with left ventricle (LV) end-systolic volume (r=0.28, p&lt;0.05) and with LV ejection fraction (r=−0.23, p&lt;0.1). According to the hospital follow-up, the 1st day count of CD14++CD16+ Mc was higher in patients with in-hospital complications (mean 42.9±6.9x106/L vs 26.6±5.3x106/L in uncomplicated cases, p&lt;0.05), and was correlated with number of in-hospital complications per patient (r=0.25, p=0.05). Conclusion Higher baseline number of CD14++CD16+ Mc correlates with other “pro-inflammatory” indices (C-RP, ESR) and indicates the worse baseline cardio-hemodynamic and unfavorable course of in-hospital period in pts with STEMI, treated with PCI. Incremental in-hospital dynamic of all Mc populations was observed in multi-vessel lesion cases. Funding Acknowledgement Type of funding source: None

The aim – to create a new method of assessing the development of long-term complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 148 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=92). Group 2 – 56 patients, who were studied prospectively. The groups of patients did not differ in clinical and anamnestic characteristics and treatment. The study provided an annual observation period. The endpoint in group 1 was: death, stroke, exacerbation of coronary heart disease – including the need for revascularization, the developement or decompensation for heart failure, which led to hospitalization (in addition, group 2 was analyzed for onset of cardiac death).Results and discussion. There complex indicators were built, based on the analysis of the clinical profile and dynamics of laboratory parameters in patients with the onset of the endpoint – a modified leukocyte index (mLI), which contains the values ​​of the number and percentage of granulocytes, lymphocytes and monocytes on days 1, 3 and 10 of STEMI and leukocyte-platelet index (mLPI), which additionally includes indicators of platelet inhomogeneity in size (PDWc and P-LCR). These indices with their limit values ​​(mLI > 140 units and mLPI > 242 units) were more informative in predicting distant cardiovascular events than other laboratory markers (including neutrophil-leukocyte ratio, NLR). In a prospective study branch (group 2), the mLI and mLPI indicators also turned out to be more informative than other markers (in particular, the NLR indicator) in determining the propensity to occur as a combined endpoint (area under the curve 0.71 for both; p>0.0001), so and death (areas under the curve 0.78 and 0.84, respectively; p>0.0001). Based on the data obtained, a computer algorithm has been created that simplifies the risk assessment in AMI patients using the developed indicators.Conclusions. Created leukocyte and leukocyte-platelet indices are highly informative in predicting the risk of complications in patients within a year after AMI.

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Institute of Cardiology, Kyiv, Ukraine The role of lymphocytes in  the progression of atherosclerosis is still unclear. T-cells helper (CD4+) and suppressor (CD8+) subtypes are activated in acute cardiac injury and myocardial infarction (AMI),including cytotoxicity mediated by CD8+ T-cells and immunoregulatory activity mediated by CD4+ T-cells (which can also enhance the CD8+ T-cell cytotoxicity). The natural killer (NK) cells are important in the infarcted myocardium, where it affects heart remodeling. The aim of the study was to identify the difference in the dynamic profile of T-cells (CD4 +, CD8 +) and NK cells (CD16 / 56+) in STEMI patients with and without complications during 1-year follow-up. Methods The composition of individual subtypes of T-cells (CD4 +, CD8 +) and NK cells (CD16 / 56+) in the venous blood was evaluated retrospectively in 60 pts with STEMI, treated with primary PCI, at admission and on day 7. The following cardiovascular events were considered as the end point in remote (1 year) observation: death, AMI, stroke, revascularization, development/decompensation of heart failure and cardiac ischemia. All patients were divided into 2 groups depending on the presence (1st group - 35 pts) and absence of endpoint (2nd group - 25 pts). Both groups were comparable by the clinical profile. Results: There were lower number of T-suppressor on day 7 in patients with cardiovascular events during long-term follow-up (357.4 ± 36.2 /μl in group 1 vs 779.7 ± 222.8 /μl in group 2, p &lt;0,01) with the trend in their percentage (23.6 ± 1.5% vs. 27.6 ± 2.3% in group 2, p &lt;0.1). In pts with poor prognosis NK cells number and percentage has tendency to increase at the admission– 45,6% vs 37,3% in the group 2. Tab 1 Conclusion We can assume that the initial tendency to increase in the number and percentage of NK cells (CD16 / 56 +) followed by a decrease in the number and percentage of T cells suppressor (CD8+) on STEMI day 7 are associates with an undesirable 1-year prognosis. Dynamics of T-cells subtypes in STEMI pGroup 1 (n = 35)Group 2 (n = 25)Р group 1 vs group 2Day1Day 7Day 1Day7T-cells suppressor (CD8+) %20,9 ± 1,623,6 ± 1,524,2 ± 2,127,6 ± 2,3&lt;0.1 on day 7T-cells suppressor (CD8+) /μl341,4 ± 40,1357,4 ± 36,2338,4 ± 46,8779,7 ± 222,8&lt;0.02 on day 7T-cells helper (CD4+) %42,0 ± 1,948,0 ± 1,345,3 ± 2,248,0 ± 2,1&gt;0.1T-cells helper (CD8+) /μl671,9 ± 72,9771,7 ± 68,0666,6 ± 94,2900,9 ± 115,8&gt;0.1Natural killer (CD16 / 56+) %18,4 ± 1,912,5 ± 1,413,4 ± 2,09,73 ± 0,96&lt;0.1 on day 1Natural killer (CD16 / 56+) /μl263,7 ± 31,9219,7 ± 33,8181,1 ± 26,7170,6 ± 25,9&lt;0.1 on day 1