The aim – to assess the additional prognostic information of metabolic syndrome (MS) components in groups of patients with acute myocardial infarction with segment elevation ST (STEMI), equalized in terms of commonly used acute coronary syndrome (ACS) risk factors. Materials and methods. Retrospective analysis of the 820 cases of STEMI included: evaluation of risk factors according to the scales TIMI, GRACE, PURSUIT, and evaluation of components of the metabolic syndrome at entry (the presence of diabetes mellitus and/or increasing glucose levels > 7 mmol/l, overweight, hypertension, dyslipidemia), as well as the assessment of the indicators of clinical course of hospital period of MI, treatment and results of follow-up of patients, including the information about cases of cardiac death. Results and discussion. Via automated «case-match-control» algorhythm from the basic cohort 2 groups were selected: group 1 (n=41, patients with MS) and group 2 (n=123, patients without MS). Matching criteria included following 13 risk factors: age, height, presence of heart failure, smoking, systemic hypotension at the 1 day of AMI, presence of anterior STEMI, the peak level of the MB-CK and AST, a history of angina and the period of unstable angina before STEMI, the presence of previous MI, baseline heart rate, baseline glomerular filtration rate (CKD-EPI), male gender. Groups were exactly matched by the first 4 matching criteria, and among other criteria maximum mismatch of 3 criteria was allowed (mean mismatch was 1.87 criteria from 13 per pair, and there were no significant differences in groups by each of 13 matching criteria). Otherwise, group 1 was characterized by more severe baseline profile, clinical course of hospital period, but it has the more intensive medical treatment also (including more frequent prescription of ACE inhibitors). According to the follow-up data, patients in group 1 had smaller end-systolic and end-diastolic indexes, more signed improvement in acute heart failure rate, higher heart rate variability and smaller dispersion of repolarisation at the 10th day. Also there was observed a trend toward a lower 3-year mortality (4,9 versus 17,1 %; p=0.05). Conclusions. The presence of MS accompanying STEMI is associated with poorer course of acute period of the disease and, in a contrary, with more favorable course of post-infarction period because of more intensive cardiac therapy in this group of patients.

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 a prognostically significant set of anamnestic (primarily cardiovascular) risk factors and indicators of the initial clinical condition in the population of patients with COVID-19, on the basis of which to develop a scale for assessing the clinical condition to identify patients with a more severe subsequent course of the disease for the individualization of treatment tactics.Materials and methods. The retrospective analysis included data on 104 patients with COVID-19 (50 men and 54 women, aged 24 to 84 years), who during 2020-2021 underwent treatment (16 days) in clinics of Ukraine within the framework of the program for studying the effectiveness of treatment COVID-19. Risk factors (advanced age, inflammatory diseases, hypertension, obesity, diabetes, coronary heart disease, heart failure (HF)), dynamics of the clinical state (heart rate, body temperature, blood pressure, SpO2, respiratory rate (RR), clinical symptoms and signs from all systems of the body) were assessed. Based on the dynamics of the clinical condition (according to a specially developed scale), all patients were divided into subgroup A (66 patients, more severe hospital course of COVID-19, ≥ 7 points) and subgroup B (38 patients, milder course of COVID-19, < 7) points).Results and discussion. Among the anamnestic risk factors (RF) of a more severe hospitalization for COVID-19, the following were more informative than others: age > 53 years (HR 1.8 (1.11–3.02)), history of coronary artery disease (HR 1.42 (1.09–1.85)) and SN (HR 1.67 (1.41–1.96)), as well as a model built taking into account all the estimated RFs according to their significance (HR = 1.88 (1.37–2.74), area under the ROC curve (ROC) 0.73). Among the clinical markers (CM) of the first day, the most informative were: RR > 20/min (HR 1.74 (1.10–2.74)), body temperature > 37.8 °C (HR 1.48 (1.13–1.94)) and a model with eight KM (HR 2.45 (1.55–3.87), ROC 0.80). The obtained scales were additive: the combined scale of RF and CM had ROC 0.84, value > 21 units on the first day of COVID-19 had a sensitivity of 76 % and a specificity of 76 % (HR 2.38 (1.58–3.58)) in predicting the adverse course of the disease during the next 16 days.Conclusions. The risk assessment system developed by us, based on clinical and anamnestic data, on the first day of treatment for COVID-19 allows predicting a more severe course of the disease. The data obtained by us require further study in a prospective study.

The aim – to compare the clinical, anamnestic characteristics and course of in-hospital period in patients of different age groups with ST-elevation acute coronary syndrome. Material and methods. Were analyzed the data of 835 patients with ST-elevation acute coronary syndrome admitted to the emergency departments from January 2000 to December 2015. Patients were divided into two groups: I group – < 45 years of age (n=189), II group ≥ 45 years (n=646). Results. The average age of patients in the I group was (37.8±6.5) years, in the II group – 59.3±8.1 years (Р<0.0001). Among the patients in group I there were more men (Р<0.0001). The mean body mass index (BMI) in young patients was 28.7±4.6 kg/m2 compared to 27.8±4.2 kg/m2 in group II (Р<0.021). The frequency of diabetes mellitus in patients of the I group was 4.2 %, arterial hypertension – 41.8 %. Young patients were much less likely to have a history of myocardial infarction or stroke and concomitant heart failure. The anterior localization of myocardial infarction in group I patients was registered in 59.8 % cases vs 51.9 % in the II group, Р=0.045; there were no significant differences regar­­ding frequency of posterior and lateral infarctions. The average time from the development of symptoms to hospitalization in the I group was 9.7±7.6 hours, and in group II – 4.5±5.3 hours (Р<0.001). Conclusions. Patients under 45 years of age with ST-elevation acute coronary syndrome are heterogeneous. The most important risk factors for the development of AMI in these patients are smoking, overweight and heredity. Hypertension and diabetes mellitus in young patients were much less frequent than in the older age group. In-hospital course of AMI in young patients was more favorable with fewer complications.

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