**2. Material and methods**

#### **2.1 Patients**

Sixty-two patients with STEMI, 51 (82.3%) male and 11 (17.7%) female, at the average age (58.63 ± 8.90) years with acute STEMI during 2–12 h of symptoms onset

*Vascular Access Surgery - Tips and Tricks*

of LV remodeling and is its predictor.

MACE group.

VEGF-A, which is formed in mononuclear cells infiltrating the infarcted myocardium, plays an important role in angiogenesis, re-endothelialization, restoration of the LV systolic function after the AMI [20]. Devaux et al. [19], determined the LV remodeling according to the EDV dynamics in the period between the patient's hospitalization and 6 months after the MI; the first group consisted of patients with ΔEDV, which did not undergo significant changes or was decreasing; group 2 included patients whose ΔEDV was increasing. The level of VEGF-B was 69% higher in patients with ΔEDV ≤ 0 than in patients with ΔEDV > 0. The authors believe that the low level of VEGF-B in blood with AMI is associated with a high risk

In accordance with the spectrum of the VEGF biological cardiovascular effects, a number of studies are devoted to the role of cytokine for the long-term prognosis in patients with MI. The contradictory results were obtained. Thus, Heeschen et al. [34], determined the level of VEGF-A in plasma of 1090 patients with ACS 8.7 h after the onset of the event. The frequency of major cardiovascular complications during the 6 months of observation was high in patients with the initially increased VEGF-A level. But other studies have obtained evidence that it is the decrease in the VEGF-A level which is an independent prognostic factor of recurrent cardiovascular events in other studies. Thus, Niu et al. [25], determined the VEGF-A level on the 7th day after MI, groups with low and high (less than or greater than 190 ng/ml) median VEGF-A levels. Repeated examinations were carried out every 2 months during the year; MACE, which included cardiovascular death, heart failure, severe arrhythmias, cardiogenic shock and post-infarction angina, were recorded. Within 6 months, the MACE frequency in the VEGF-A high-level group was significantly lower than in the low-cytokine group. Accordingly, the VEGF-A concentration in the group of patients without MACE was significantly higher than that in the

Multivariant regression analysis showed that the decrease of the VEGF-A level is an independent MACE risk factor, its high value on the 7th day after AMI determines a positive long-term prognosis. Matsudaira et al. [27], examined 879 patients with AMI after successful PCI within the framework of a prospective, multicenter NAMIS study (Nagoya Acute Myocardial Infarction Study). According to VEGF-A level terciles, which was determined on the 7th day of AMI, 3 groups were formed, in which within 6 months of observation the major unfavorable cardiac and cerebral events were determined: cardiac death, repeated ACS, hospitalization for heart failure, strokes. Compared to the "medium" tercile, patients with the "low" tercile had a much higher risk of MACE. The authors believe that the low of VEGF-A level on the 7th day after

It is known that psychological stress is involved in the development and progression of cardiovascular disease. Thus, in an INTERHEART study performed in 52 world countries, anxiety and depression ranked third among the MI risk factors [36]. In Surtees et al. [37], within the 8.5 years period of observation, patients with a

AMI is associated with a significant increase in the MACE risk for 6 months. Unlike the previous authors, Ramos et al. [17], determined that the level of VEGF-A in patients with AMI was lower than that of healthy individuals at admission, it was getting increased within 1 month term and remained steadily increased up to 1 year of observation. But in this study, it was shown that a decrease in the VEGF-A level < 40.8 pg./ml contributed to an increased risk of MACE for 5 years. The obtained results indicated the positive role of VEGF-A in the cardiovascular circulation restoration and confirmed its prognostic importance. In studies of Teplyakov et al. [35], the degree of ischemic genesis cardiac failure progression, most of the examined were postinfarction patients, there was a decrease in the VEGF-A level, and the initial low VEGF-A level characterized the

**124**

unfavorable CHF course.

in a given period between 2016 and 2017. STEMI was diagnosed according to ECS Guidelines [53]. Inclusion criteria were: confirmed STEMI, age >18 years old, and lack of contraindication to PCI. Non-inclusion criteria were previous myocardial infarction, established chronic HFrEF, HFmrEF and HFpEF, known malignancy, severe comorbidities (anemia, chronic obstructive lung disease, bronchial asthma, liver cirrhosis, chronic kidney disease, valvular heart disease, bleeding), inability to understand of written informed consent. Control group consisted of 20 persons comparable of age and sex. Patients were hospitalized to the Department of prevention and treatment of emergency conditions of Government institution "L.T. Malaya Therapy National Institute of the National Academy of medical science of Ukraine" after selective coronaroangiography (SCAG) with stenting of infarctrelated artery, were performed in the Institute of general and emergency surgery n.a. V.T. Zaitsev. Repeated observation performed after 6 month.

Research was performed due to Helsinki Declaration, the protocol was approved by local ethics committee of GI "National Institute of therapy n.a. L.T.Malaya NAMS Ukraine" (protocol No. 8, 29.08.2016). Informed consent was obtained from each patient.

Conventional coronary angiography was performed using Digital X-Ray system "Integris Allura" (Philips Healthcare, Best, The Netherlands) and managed by radial or femoral vascular access. Coronary arteries were visualized with twoto-three orthogonal projections. In this study the contrast "Ultravist-370" (Baier Pharma GmbH, Germany) and automatic contrast injector were used. Primary PCI with bare-metal stent (COMMANDER, "Alvimedica", Turkey) implantation was performed in 36 patients and 26 patients were previously treated with primary thrombolysis (tenecteplase, alteplase) before admission with followed PCI during 6–12 h after initial STEMI confirmation. Thrombolytic therapy performed by tenecteplase, which dosing was calculated depending on patients weight and was no more than 50 mg or alteplase, or tenecteplase—100 mg. All the patients intook medical therapy in accordance to existing recommendations.

Repeated coronary events (after infarction angina) during 6-month observation period were estimated and diagnosed in 9 (14.5%) patients. Left ventricular remodeling as an end point in 6 months after STEMI were assessed too: adverse remodeling was in 29 patients, adaptive—in 33.

#### **2.2 Methods**

SYNTAX score (SS) was used to assess the severity of coronary atherosclerotic lesions and was calculated for all PCI-patients by experienced interventional cardiologist. SS was determined for all coronary lesions >50% diameter stenosis in a vessel >1.5 mm based on SS calculator (www.syntaxscore.com). All the patients were divided by the SS level on 3 subgroups—high SS > 32–2 patients, average SS 22 < n ≤ 32–17, low SS ≤ 22–32.

Echo-CG was performed on "Aplio 500 TUS-A500", Toshiba, with usage of sensor with ultrasound frequency of 3.5 MHz during first 24 h from hospitalization. Left ventricular end diastolic volume (LV EDV), left ventricular end systolic volume (LV ESV), left ventricular end diastolic and end systolic diameters (LV EDD, LV ESD), left ventricular myocardial mass (LVMM), left ventricular ejection fraction (LVEF), diastolic dysfunction—maximal rate of early diastolic filling E (m/s), maximal rate of left atrium diastolic rate A (m/s), their ratio—E/A were estimated. Repeated observation was done after 6-month period. VEGF-A level was assessed on the 7th day of STEMI. Late adverse cardiac remodeling was defined as increased LVEDV (>10% from baseline) and/or LVESV (>10% from baseline) for 6 months after acute STEMI managed by PCI.

**127**

*Promising Role of Vascular Endothelial Growth Factor-A in Risk Stratification after PCI*

Hypercholesterolemia (HCE) was diagnosed if total cholesterol (TC) level was above 5.2 mmol/l, and/or low density lipoprotein cholesterol (LDL) level was above 3.0 mmol/l, and/or level of triglycerides (ТG) was above 1.7 mmol/l according to with European Cardiology Society dyslipidemia guideline, 2016. Hypertension was diagnosed if systolic blood pressure (SBP) was >140 mm Hg, and/or diastolic blood pressure (DBP) >90 mm Hg according to European guideline on diagnostics and treatment of arterial hypertension, 2018. Type 2 diabetes mellitus determined

The level of anxiety during 10–14 days before STEMI estimated due to Taylor questionnaire. High level of anxiety was consistent with less or equal 14 balls, high level—more than 14 balls. Together with Taylor questionnaire, Heart Anxiety and Depression Scale (HADS) was used to diagnose anxiety and depression: 0–7 balls—

Troponin I (Tn I) level measuring performed with chemo luminescent immunoassay (Humalyzer 2000, Mannheim, Germany). The TnI level average was 0.5–50 ng/ml. Total creatine kinase (CK) and CK MB-fraction (CK-MB) were analyzed using immunoinhibition method on quantitative immunoassay analyzer Humalyzer 2000 (Mannheim, Germany) according to the manufacturers' recommendations. Total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides (TG) were measured direct enzymatic method (Roche P800 analyzer, Basel, Switzerland). The intraassay and inter-assay coefficients of variation were <5%. Fasting glucose level was measured by a double-antibody sandwich immunoassay (Elecsys 1010 analyzer, F. Hoffmann-La Roche Diagnostics, Mannheim, Germany). The intra-assay and

Blood research were done at baseline. VEGF-A level determined by enzymelinked immunosorbent assay with reactives of IBL INTERNATIONAL GMBH, Germany (standard concentrations diapason 0.0–1000 pg./ml, serum control: low—100–200, high—600–1200 pg./ml) in the laboratory of immune-chemical and molecular-genetic researches of GI "National Institute of therapy n.a. L.T. Malaya NAMS Ukraine". Serum VEGF-A level measured in the 7th day of STEMI: in the main group it was equal 160.33 [83.82–299.62] pg./ml, in the control

Statistical data processing was performed with programs Statistica 8.0 (Stat Soft Inc., USA), median (Ме) with upper (UQ ) and low quartiles (LQ ). Continuous variables are presented as mean ± standard deviation when normally distributed, or median and interquartile range if otherwise. Mann-Whitney U-criterion and

of analysis, all differences were considered statistically significant with P < 0.05. Univariate and multivariate logistic statistical analyses were used. The group with repeated coronary events pointed as 1, without events—0, cut-off point with

The first group with repeated coronary events (after infarction angina) represented 9 patients (14.5%), the second group consisted from 53 patients without angina to 6 months after STEMI. Cardiovascular risk factors [sex, age, H, DM, HCE, complicated heredity, anxiety-depressive disorders (ADD)] showed the


*DOI: http://dx.doi.org/10.5772/intechopen.82712*

according to new ADA statement [54].

low level, 8–10—borderline, 11–21—high.

inter-assay coefficients of variation were <5%.

group—112.30 [75.45–164.65] pg./ml (Р = 0.05).

**2.3 Statistical analyses**

Wald-Wolfowitz χ<sup>2</sup>

VEGF-A were found.

**3. Results**

#### *Promising Role of Vascular Endothelial Growth Factor-A in Risk Stratification after PCI DOI: http://dx.doi.org/10.5772/intechopen.82712*

Hypercholesterolemia (HCE) was diagnosed if total cholesterol (TC) level was above 5.2 mmol/l, and/or low density lipoprotein cholesterol (LDL) level was above 3.0 mmol/l, and/or level of triglycerides (ТG) was above 1.7 mmol/l according to with European Cardiology Society dyslipidemia guideline, 2016. Hypertension was diagnosed if systolic blood pressure (SBP) was >140 mm Hg, and/or diastolic blood pressure (DBP) >90 mm Hg according to European guideline on diagnostics and treatment of arterial hypertension, 2018. Type 2 diabetes mellitus determined according to new ADA statement [54].

The level of anxiety during 10–14 days before STEMI estimated due to Taylor questionnaire. High level of anxiety was consistent with less or equal 14 balls, high level—more than 14 balls. Together with Taylor questionnaire, Heart Anxiety and Depression Scale (HADS) was used to diagnose anxiety and depression: 0–7 balls low level, 8–10—borderline, 11–21—high.

Troponin I (Tn I) level measuring performed with chemo luminescent immunoassay (Humalyzer 2000, Mannheim, Germany). The TnI level average was 0.5–50 ng/ml. Total creatine kinase (CK) and CK MB-fraction (CK-MB) were analyzed using immunoinhibition method on quantitative immunoassay analyzer Humalyzer 2000 (Mannheim, Germany) according to the manufacturers' recommendations. Total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides (TG) were measured direct enzymatic method (Roche P800 analyzer, Basel, Switzerland). The intraassay and inter-assay coefficients of variation were <5%. Fasting glucose level was measured by a double-antibody sandwich immunoassay (Elecsys 1010 analyzer, F. Hoffmann-La Roche Diagnostics, Mannheim, Germany). The intra-assay and inter-assay coefficients of variation were <5%.

Blood research were done at baseline. VEGF-A level determined by enzymelinked immunosorbent assay with reactives of IBL INTERNATIONAL GMBH, Germany (standard concentrations diapason 0.0–1000 pg./ml, serum control: low—100–200, high—600–1200 pg./ml) in the laboratory of immune-chemical and molecular-genetic researches of GI "National Institute of therapy n.a. L.T. Malaya NAMS Ukraine". Serum VEGF-A level measured in the 7th day of STEMI: in the main group it was equal 160.33 [83.82–299.62] pg./ml, in the control group—112.30 [75.45–164.65] pg./ml (Р = 0.05).

#### **2.3 Statistical analyses**

*Vascular Access Surgery - Tips and Tricks*

each patient.

**2.2 Methods**

22 < n ≤ 32–17, low SS ≤ 22–32.

acute STEMI managed by PCI.

in a given period between 2016 and 2017. STEMI was diagnosed according to ECS Guidelines [53]. Inclusion criteria were: confirmed STEMI, age >18 years old, and lack of contraindication to PCI. Non-inclusion criteria were previous myocardial infarction, established chronic HFrEF, HFmrEF and HFpEF, known malignancy, severe comorbidities (anemia, chronic obstructive lung disease, bronchial asthma, liver cirrhosis, chronic kidney disease, valvular heart disease, bleeding), inability to understand of written informed consent. Control group consisted of 20 persons comparable of age and sex. Patients were hospitalized to the Department of prevention and treatment of emergency conditions of Government institution "L.T. Malaya Therapy National Institute of the National Academy of medical science of Ukraine" after selective coronaroangiography (SCAG) with stenting of infarctrelated artery, were performed in the Institute of general and emergency surgery

Research was performed due to Helsinki Declaration, the protocol was approved

Conventional coronary angiography was performed using Digital X-Ray system

Repeated coronary events (after infarction angina) during 6-month observation period were estimated and diagnosed in 9 (14.5%) patients. Left ventricular remodeling as an end point in 6 months after STEMI were assessed too: adverse

SYNTAX score (SS) was used to assess the severity of coronary atherosclerotic

Echo-CG was performed on "Aplio 500 TUS-A500", Toshiba, with usage of sensor with ultrasound frequency of 3.5 MHz during first 24 h from hospitalization. Left ventricular end diastolic volume (LV EDV), left ventricular end systolic volume (LV ESV), left ventricular end diastolic and end systolic diameters (LV EDD, LV ESD), left ventricular myocardial mass (LVMM), left ventricular ejection fraction (LVEF), diastolic dysfunction—maximal rate of early diastolic filling E (m/s), maximal rate of left atrium diastolic rate A (m/s), their ratio—E/A were estimated. Repeated observation was done after 6-month period. VEGF-A level was assessed on the 7th day of STEMI. Late adverse cardiac remodeling was defined as increased LVEDV (>10% from baseline) and/or LVESV (>10% from baseline) for 6 months after

lesions and was calculated for all PCI-patients by experienced interventional cardiologist. SS was determined for all coronary lesions >50% diameter stenosis in a vessel >1.5 mm based on SS calculator (www.syntaxscore.com). All the patients were divided by the SS level on 3 subgroups—high SS > 32–2 patients, average SS

by local ethics committee of GI "National Institute of therapy n.a. L.T.Malaya NAMS Ukraine" (protocol No. 8, 29.08.2016). Informed consent was obtained from

"Integris Allura" (Philips Healthcare, Best, The Netherlands) and managed by radial or femoral vascular access. Coronary arteries were visualized with twoto-three orthogonal projections. In this study the contrast "Ultravist-370" (Baier Pharma GmbH, Germany) and automatic contrast injector were used. Primary PCI with bare-metal stent (COMMANDER, "Alvimedica", Turkey) implantation was performed in 36 patients and 26 patients were previously treated with primary thrombolysis (tenecteplase, alteplase) before admission with followed PCI during 6–12 h after initial STEMI confirmation. Thrombolytic therapy performed by tenecteplase, which dosing was calculated depending on patients weight and was no more than 50 mg or alteplase, or tenecteplase—100 mg. All the patients intook

n.a. V.T. Zaitsev. Repeated observation performed after 6 month.

medical therapy in accordance to existing recommendations.

remodeling was in 29 patients, adaptive—in 33.

**126**

Statistical data processing was performed with programs Statistica 8.0 (Stat Soft Inc., USA), median (Ме) with upper (UQ ) and low quartiles (LQ ). Continuous variables are presented as mean ± standard deviation when normally distributed, or median and interquartile range if otherwise. Mann-Whitney U-criterion and Wald-Wolfowitz χ<sup>2</sup> - criterion were used for intergroup differences. For all types of analysis, all differences were considered statistically significant with P < 0.05. Univariate and multivariate logistic statistical analyses were used. The group with repeated coronary events pointed as 1, without events—0, cut-off point with VEGF-A were found.

### **3. Results**

The first group with repeated coronary events (after infarction angina) represented 9 patients (14.5%), the second group consisted from 53 patients without angina to 6 months after STEMI. Cardiovascular risk factors [sex, age, H, DM, HCE, complicated heredity, anxiety-depressive disorders (ADD)] showed the

absence of reliable differences between patients of group 1 and 2. VEGF-A level was significantly less in patients from group 1:83.82 [49.14–162.26] pg./ml versus 194.10 [102.54–327.30] pg./ml accordantly, Р = 0.049.

ROC-analysis was performed to find VEGF-A level which prognoses repeated coronary events after 6-month observation after STEMI. Cut-off VEGF-A level ≤ 172.4 pg./ml on the 7th day of index event (area under curve (AUC) 0.697, with sensitivity 88.9% and specificity 50.9%; 95% CІ 0.567–0.807, Р = 0.0515) was effective for differentiation STEMI patients from those without and with unfavorable prognosis of repeated coronary event—after infarction angina (**Figure 1**).

To identify factors influenced on VEGF-A level, univariate and multivariate logistic analysis were performed. In patients with STEMI was revealed association between anxiety and depression levels increase and VEGF-A level decrease (anxiety (Taylor): OR 0.834, 95% CІ 0.726–0.959, Р = 0.0107; depression (HADS): OR 0.741, 95% CІ 0.535–1.027, Р = 0.0519.

ROC-analysis for prognostication of dysadaptive left ventricular remodeling was used. Cut-off VEGF-A level ≤ 201.86 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.711, with sensitivity 85.7% and specificity 57.9%; 95% CІ 0.513–0.908, Р = 0.036) was effective for unfavorable prognosis of dysadaptive left ventricular remodeling of STEMI patients after 6-month observation period (**Figure 2**).

As a result of our research, we revealed than anxiety and depression 10–14 days before MI associated with VEGF-A level decrease (anxiety (Taylor): OR 0.834, 95% CІ 0.726–0.959, Р = 0.0107; depression (HADS): OR 0.741, 95% CІ 0.535–1.027, Р = 0.0519. VEGF-A decrease ≤172.4 pg./ml on the 7th day of STEMI allows to prognose

#### **Figure 1.**

*Cut-off VEGF-A level* ≤ *172.4 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.697, with sensitivity 88.9% and specificity 50.9%; 95% CІ 0.567–0.807, Р = 0.0515) was effective for differentiation STEMI patients from those without and with unfavorable prognosis of repeated coronary event (after infarction angina after 6-month observation).*

**129**

**4. Conclusion**

**Figure 2.**

**Acknowledgements**

**Conflict of interest**

coronary revascularization at risk of HF.

There are no conflicts of interest.

*Promising Role of Vascular Endothelial Growth Factor-A in Risk Stratification after PCI*

repeated coronary events (after infarction angina) after 6-month observation with sensitivity of 88.9% and specificity 50.9%. Cut-off VEGF-A level ≤ 201.86 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.711, with sensitivity 85.7% and specificity 57.9%; 95% CІ 0.513–0.908, Р = 0.036) was effective for prognosis of dysadaptive left

*Cut-off VEGF-A level* ≤ *201.86 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.711, with sensitivity 85.7% and specificity 57.9%; 95% CІ 0.513–0.908, Р = 0.036) was effective for unfavorable prognosis of* 

*dysadaptive left ventricular remodeling in STEMI patients after 6-month observation period.*

We have shown that the levels of VEGF-A measured in acute STEMI patients managed by PCI could predict late adverse LV remodeling and after infarction angina. These findings may open new approach to stratify patients with successful

There are no previous presentations of the information reported in the article. We thank Nataliia Tytarenko and Igor Polivenok for performing ultrasound examination and cardiac interventions respectively. Additionally, we thank, Galina Bugrimenko for her excellent technical assistance. Permission to acknowledge has been obtained.

ventricular remodeling in STEMI patients after 6-month observation period.

*DOI: http://dx.doi.org/10.5772/intechopen.82712*

*Promising Role of Vascular Endothelial Growth Factor-A in Risk Stratification after PCI DOI: http://dx.doi.org/10.5772/intechopen.82712*

**Figure 2.**

*Vascular Access Surgery - Tips and Tricks*

95% CІ 0.535–1.027, Р = 0.0519.

[102.54–327.30] pg./ml accordantly, Р = 0.049.

absence of reliable differences between patients of group 1 and 2. VEGF-A level was significantly less in patients from group 1:83.82 [49.14–162.26] pg./ml versus 194.10

ROC-analysis was performed to find VEGF-A level which prognoses repeated

ROC-analysis for prognostication of dysadaptive left ventricular remodeling was used. Cut-off VEGF-A level ≤ 201.86 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.711, with sensitivity 85.7% and specificity 57.9%; 95% CІ 0.513–0.908, Р = 0.036) was effective for unfavorable prognosis of dysadaptive left ventricular remodeling of STEMI patients after 6-month observation period (**Figure 2**).

As a result of our research, we revealed than anxiety and depression 10–14 days before MI associated with VEGF-A level decrease (anxiety (Taylor): OR 0.834, 95% CІ 0.726–0.959, Р = 0.0107; depression (HADS): OR 0.741, 95% CІ 0.535–1.027,

Р = 0.0519. VEGF-A decrease ≤172.4 pg./ml on the 7th day of STEMI allows to prognose

*Cut-off VEGF-A level* ≤ *172.4 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.697, with sensitivity 88.9% and specificity 50.9%; 95% CІ 0.567–0.807, Р = 0.0515) was effective for differentiation STEMI patients from those without and with unfavorable prognosis of repeated coronary event (after infarction angina* 

level ≤ 172.4 pg./ml on the 7th day of index event (area under curve (AUC) 0.697, with sensitivity 88.9% and specificity 50.9%; 95% CІ 0.567–0.807, Р = 0.0515) was effective for differentiation STEMI patients from those without and with unfavorable prognosis of repeated coronary event—after infarction angina (**Figure 1**). To identify factors influenced on VEGF-A level, univariate and multivariate logistic analysis were performed. In patients with STEMI was revealed association between anxiety and depression levels increase and VEGF-A level decrease (anxiety (Taylor): OR 0.834, 95% CІ 0.726–0.959, Р = 0.0107; depression (HADS): OR 0.741,

coronary events after 6-month observation after STEMI. Cut-off VEGF-A

**128**

**Figure 1.**

*after 6-month observation).*

*Cut-off VEGF-A level* ≤ *201.86 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.711, with sensitivity 85.7% and specificity 57.9%; 95% CІ 0.513–0.908, Р = 0.036) was effective for unfavorable prognosis of dysadaptive left ventricular remodeling in STEMI patients after 6-month observation period.*

repeated coronary events (after infarction angina) after 6-month observation with sensitivity of 88.9% and specificity 50.9%. Cut-off VEGF-A level ≤ 201.86 pg./ml on the 7th day of STEMI (area under curve (AUC) 0.711, with sensitivity 85.7% and specificity 57.9%; 95% CІ 0.513–0.908, Р = 0.036) was effective for prognosis of dysadaptive left ventricular remodeling in STEMI patients after 6-month observation period.

#### **4. Conclusion**

We have shown that the levels of VEGF-A measured in acute STEMI patients managed by PCI could predict late adverse LV remodeling and after infarction angina. These findings may open new approach to stratify patients with successful coronary revascularization at risk of HF.

#### **Acknowledgements**

There are no previous presentations of the information reported in the article. We thank Nataliia Tytarenko and Igor Polivenok for performing ultrasound examination and cardiac interventions respectively. Additionally, we thank, Galina Bugrimenko for her excellent technical assistance. Permission to acknowledge has been obtained.

#### **Conflict of interest**

There are no conflicts of interest.
