The aim of the study was to compare the 1-year results of conservative and invasive tactics of treating myocardial infarction (MI) in patients with different severity of comorbid background.Material and methods. The presented results are based on registry in City Hospital No. 4 of Sochi. The present analysis included patients with a diagnosis of myocardial infarction (n = 1 176). Upon discharge from the hospital, all patients underwent analysis of the severity of comorbidity using the Charlson Comorbidity Index (CCI). A year later, 791 patients managed to find out the prognosis after discharge from the hospital. 1-year mortality was 12.6 % (n = 100).Results. The frequency of coronary angiography (CA) and percutaneous coronary intervention (PCI) in patients with CCI = 0 (no or minimal comorbidity, n = 408) was 84.3 % and 63.5 %, with a CCI of 1–2 (moderate comorbidity), n = 438) was 68.0 % and 44.8 %, with CCI ≥ 3 (expressed comorbidity, n = 330) was 50.3 % and 25.8 %, respectively. At the same time, conducting PCI at the hospital observation stage was associated with a decrease mortality during the year after discharge from the hospital from 18.5 % to 5.8 %, p < 0.0001. The greatest positive effect of PCI for optimizing the long-term prognosis of (1 year) was achieved in the group of patients with severe comorbidity (CCI ≥ 3), where the NNT (number needed to treat) was 7. The relative risk of 1-year mortality in patients with severe comorbidity compared to the minimum in the PCI group was 6.75, in the conservative treatment group was 4.63.Conclusion. The results of this study showed that PCI in MI is more often performed by younger, less comorbid patients with a lower risk on the GRACE scale. At the same time, the 1-year survival of patients with MI was significantly higher after PCI compared to the primary conservative treatment strategy, regardless of the severity of comorbidity, and the greatest improvement in the long-term prognosis of PCI was observed in patients with severe comorbidity, as determined by the CCI ≥ 3.

Aim. To assess the possibilities of using comorbidity indices together with the GRACE (Global Registry of Acute Coronary Events) scale to assess the risk of hospital mortality in acute coronary syndrome (ACS). Materials and methods. The registry study included 2,305 patients with ACS. The frequency of coronary angiography was 54.0%, percutaneous coronary intervention (PCI) 26.9%. Hospital mortality with ACS was 4.8%, with myocardial infarction 9.4%. All patients underwent a comorbidity assessment according to the CIRS system (Cumulative Illness Rating Scale), according to the CCI (Charlson Comorbidity Index) and the CDS (Chronic Disease Score) scale, according to their own scale, which is based on the summation of 9 diseases (diabetes mellitus, atrial fibrillation, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia, anemia, chronic kidney disease). All patients underwent a mortality risk assessment using the GRACE ACS Risk scale. Results. It was found that the CDS and CIRS indices are not associated with the risk of hospital mortality. With CCI3, the frequency of death outcomes increased from 4.1 to 6.1% (2=4.12, p=0.042). With an increase in the severity of comorbidity from minimal (no more than 1 disease) to severe (4 or more diseases) according to its own scale, hospital mortality increased from 1.2 to 7.4% (2=23.8, p0.0001). In contrast to other scales of comorbidity, our own model more efficiently estimates the hospital prognosis both in the conservative treatment group (2=8.0, p=0.018) and in the PCI group (2=28.5, p=0.00001). It was in the PCI subgroup that the comorbidity factors included in their own model made it possible to increase the area under the ROC curve of the GRACE scale from 0.80 (0.740.87) to 0.90 (0.850.95). Conclusion. CCI and its own comorbidity model, but not CDS and CIRS, are associated with the risk of hospital mortality. The model for assessing comorbidity on a 9-point scale, but not CCI, CDS and CIRS, can significantly improve the predictive value of the GRACE scale.

The aim of the study. To compare different methods for assessing comorbidity in terms of its long-term predictive value after myocardial infarction (MI).Materials and methods. The analysis included 1176 patients with MI who were consecutively admitted to the hospital. The incidence of STsegment elevation MI was 60%; every second patient underwent endovascular intervention. All patients underwent an analysis of the severity of comorbidity according to the CIRS system (Cumulative lllness Rating Scale), according to the CCI (the Charlson’s comorbidity index), the CDS scale of chronic diseases (Chronic Disease Score), as well as according to their own model ‘K9’ (patent RU2734993C1 dated 10.27.2020) based on the summation of nine diseases: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia.Results. Long-term mortality was 12.1 %. In Cox regression analysis of long-term survival after MI, the K9 model showed the best operational characteristics with a p < 0.00001 level. In multivariate analysis, when comorbidity data were added to GRACE, an increase in the χ2 value for GARCE + CCI and GRACE + K9 to 102.5 and 99.3, respectively, and the values of the area under the ROC curve to 0.78 (0.74–0, 82) and 0.77 (0.72–0.81), respectively. Regardless of the initial level of risk assessed by the GRACE scale, severe comorbidity (four or more diseases according to the K9) significantly increased the relative risk of mortality. In patients with severe comorbidity, the predictive value of the GRACE scale was the lowest.Conclusions. Among the analyzed methods of assessing comorbidity, only CCI and its own K9 scale have an acceptable predictive value, allowing better adaptation of the GRACE scale for stratification of the long-term risk of death after MI. At the same time ‘K9’, based on the summation of nine previously described diseases, is much more convenient than CCI in practical application

Aim        To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods        The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results   Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion            This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification.