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**1. Introduction**

**Chapter 5**

**Abstract**

*and Ganna S. Isayeva*

Promising Role of Vascular

Risk Stratification after PCI

patients with successful coronary revascularization at risk of HF.

**Keywords:** vascular endothelial growth factor-A, STEMI, prognostication

Vascular endothelial growth factor-A (VEGF-A) plays a key role in inducing angiogenesis. Angiogenesis is a multifunctional process of new vessels formation by gemmation or by cleavage of the already existing ones. There are the following successive stages of angiogenesis: (1) vasodilatation; (2) migration with adhesion and proliferation of endothelial cells; (3) formation of the vascular wall of a new three-layer vascular tube that develops as the circulation restores [1]. The VEGF was discovered in 1983 [2] as a factor raising vascular permeability, further evidence of a wider range of cytokine activity was obtained. There are 7 representatives of the VEGF family—VEGF-A, B, C, D, E, F, the growth factor of the placenta. The most common is VEGF-A, which is a homodimeric highly glycosylated protein with the molecular weight of 36–46 kDa. VEGF is registered in the heart, lungs, kidneys, adrenal glands, liver, spleen, stomach, and expression of the protein grows

*Olga V. Petyunina, Mykola P. Kopytsya, Iurii S. Rudyk* 

Vascular endothelial growth factor-A (VEGF-A), dimeric glycoprotein, is a potent endothelial cell-specific mitogen which plays a key role in angiogenesis, especially in response to ischemia. Biomarkers reflect various pathophysiological faces of spherical LV transformation that related to myocardial stress due to persisted ischemia, fibrosis, and inflammation, and they may be helpful to improve risk stratification, more personalized medical approach for creating of individual medical care for HF preventing and adjusted treatment after STEMI. VEGF-A decrease ≤172.4 pg./ ml on the 7th day of STEMI allows to prognose after infarction angina after 6-month observation (area under curve (AUC) 0.697, with sensitivity 88.9% and specificity 50.9%; 95% CI 0.567–0.807, P = 0.0515). 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. Cut-off VEGF-A level ≤201.86 pg./ml on the 7th day of STEMI (AUC 0.711, 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. These findings may open new approach to stratify

Endothelial Growth Factor-A in
