Comprehensive assessment of the long-term prognosis of patients after ST-segment elevation myocardial infarction
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https://orcid.org/0000-0002-8982-7578
Abstract
The aim – to develop a validated scale for predicting long-term prognosis after ST-elevation myocardial infarction (STEMI), taking into account both clinical, laboratory, and instrumental parameters and the morphological features of intracoronary thrombi.
Materials and methods. The study included 100 patients with STEMI aged 57.81 ± 10.26 years. They underwent primary percutaneous coronary intervention within 12 (7.00 [4.75; 10.00]) hours of the onset of the disease, which also included manual thrombus aspiration. Not only clinical, laboratory, or instrumental parameters were determined in patients, but also the morphological structure of intracoronary thrombi. The prognosis was assessed by the occurrence of one of the three events studied: death, myocardial infarction, and coronary revascularization. The duration of observation was two years.
Results. The analysis included 24 clinical, anamnestic, laboratory, or instrumental parameters, as well as 5 morphologic signs of intracoronary thrombi. From the set of factors that were studied in the course of the work, three factors have been identified by the method of logistic regression, which, when combined, have an impact on the risk of developing the events. One factor has a preventive effect (layered thrombus structure), and two factors have a provocative effect (arterial hypertension, chronic kidney disease). The formula for calculating Z to determine the probability of the influence of the selected factors on the occurrence of the studied events is as follows: Z = - 3.35 - 1.08 . X1 + 2.58 . X2 + 1.37 . X3, where X1 is a layer structure (possible options are 1 or 0), X2 is arterial hypertension, and X3 is chronic kidney disease. The sensitivity of the model is 75.00 % and the specificity is 75.68 %. The total ratio of correctly predicted (positive and negative) cases is 75.56 %.
Conclusions. A comprehensive determination of the prognosis of STEMI using a scale that includes clinical, anamnestic, laboratory, instrumental and morphological examinations may provide an additional means of risk stratification in such patients.
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