Management of Patients With St-Segment Elevation Acute Coronary Syndrome in Interventional Cardiology Units: Record-3 Registry Data

Aim To identify early predictors for progression of chronic heart failure (CHF) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods The study included 113 patients with STEMI aged 52 (95 % confidence interval, 36 to 65) years. 24-h ECG monitoring was performed with assessment of ventricular late potentials, QT dispersion, heart rhythm turbulence (HRT), and heart rhythm variability (HRV); XStrain 2D echocardiograpy with determination of volumetric parameters, myocardial strain characteristics and velocities; and measurement of brain natriuretic peptide (BNP) concentrations. The endpoint was CHF progression during 48 weeks of follow-up, which was observed in 26 (23 %) patients. Based on the outcome, two groups were isolated, with CHF progression (Prg) (26(23%)) and with a relatively stable CHF postinfarction course (Stb) (87 (77 %)).Results At 12 weeks following MI, the Prg group showed increases in left ventricular (LV) end-diastolic dimension (EDD) (р<0.05) and end-diastolic and end-systolic volumes (EDV, ESV), (р<0.01), and EDV and ESV indexes (EDVi and ESVi, р<0.01). In this group, global longitudinal strain (GLS) was decreased at 24 weeks (р<0.05) and global radial strain (GRS) was decreased at 48 weeks (р=0.0003). In the Prg group, values of strain parameters (GLS, global circular strain (GCS), and GRS) were lower at all times. At 7-9 days, 24 weeks, and 48 weeks, the proportion of patients with pathological HRT was higher in the Prg group (38, 27, and 19 % for the Prg group vs 14 % (р=0.006); 3,4 % (р=0.001), and 2.3 % (р=0.002) for the Stb group, respectively). Only in the Stb group, increases in HRV were observed (SDNNi by 13 % (р=0.001), rMSSD by 24 % (р=0.0002), TotP by 49 % (р=0.00002), VLfP by 23 % (р=0.003), LfP by 22 % (р=0.008), and HfP by 77 % (р=0.002). At 7-9 days of MI, the Stb group had greater values of SDANN (р=0.013) and HfP (р=0.01). CHF progression correlated with abnormal values of turbulence onset (TO), disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. Combined assessment of HRT, LV ESD, and GLS at 7–9 days after STEMI allows identifying patients with high risk for CHF progression in the next 48 weeks.Conclusion The markers for CHF progression after STEMI include abnormal TO values, disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. The multifactor logistic regression analysis revealed early predictors of CHF in the postinfarction period, including abnormal TO, increased LV ESD, and reduced GLS.

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Early Predictors of Heart Failure Progression in Patients After Myocardial Infarction

Олейников

Душина

Голубева

et al. 2020

Kardiologiia

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The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

et al. 2021

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Aim To develop a scale (score system) for predicting the individual risk of in-hospital death in patients with ST segment elevation acute myocardial infarction (STEMI) with an account of results of percutaneous coronary intervention (PCI).Material and methods The analysis used data of 1 649 sequential patients with STEMI included into the hospital registry of PCI from 2006 through 2017. To test the model predictability, the original sample was divided into two groups: a training group consisting of 1150 (70 %) patients and a test group consisting of 499 (30 %) patients. The training sample was used for computing an individual score. To this purpose, β-coefficients of each variable obtained at the last stage of the multivariate logistic regression model were subjected to linear transformation. The scale was verified using the test sample.Results Seven independent predictors of in-hospital death were determined: age ≥65 years, acute heart failure (Killip class III-IV), total myocardial ischemia time ≥180 min, anterior localization of myocardial infarction, failure of PCI, SYNTAX scale score ≥16, glycemia on admission ≥7.78 mmol/l for patients without a history of diabetes mellitus and ≥14.35 mmol/l for patients with a history of diabetes mellitus. The contribution of each value to the risk of in-hospital death was ranked from 0 to 7. A threshold total score of 10 was determined; a score ≥10 corresponded to a high probability of in-hospital death (18.2 %). In the training sample, the sensitivity was 81 %, the specificity was 80.6 %, and the area under the curve (AUC) was 0.902. In the test sample, the sensitivity was 96.2 %, the specificity was 83.3 %, and the AUC was 0.924.Conclusion The developed scale has a good predictive accuracy in identifying patients with acute STEMI who have a high risk of fatal outcome at the hospital stage.

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Percutaneous coronary interventions for ST elevation myocardial infarction in different age groups

Бессонов

Gorbatenko

et al. 2021

Sibirskij nauchnyj medicinskij zhurnal

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Given the global trend of population aging, it is natural to see an increase in the number of percutaneous coronary interventions (PCI) performed in patients of older age groups.The aim of this study was to compare the results of percutaneous coronary interventions (PCI) in different age groups and find a predictors of hospital mortality. Methods. Data were collected from 1649 patients with STEMI who were admitted to the coronary care unit and underwent PCIs from2006 to 2017. Patients were divided into 3 age groups according to World Heals Organization classification. The first group consisted of 850 patients aged from 18 to 59 years, the second group consisted 620 patients aged from 60 to 74 years, and third group consisted of 179 patients aged from 75 years and older. Results. The rate of in-hospital death was statistically significant lower in younger groups (groups 1-2: 2.2 % vs 5.8 %, р<0.001; groups 1-3: 2.2 % vs 16.2 %, р<0.001; 2-3: 5.8 % vs 16.2 %, р<0.001). After multivariate adjustment the independent predictor of death were age (odds ratio (OR) =1.08; 95 % confidence interval (CI) 1.05-1.11, р<0.001), anterior myocardial infarction (OR=2.03; 95 % CI 1.15-3.59, р=0.015), Syntax score (OR=1.05; 95 % CI 1.02-1.09, р=0.001), ventricular arrhythmias (OR=4.98; 95 % CI 2.49-9.96, р<0.001), blood glucose level at admission (OR=1.06; 95 % CI 1.01-1.13, р=0.040), PCI failure (OR=5.05; 95 % CI 2.47-10.3, р<0.001), Killip class III-IV (OR=6.01; 95 % CI 3.12–11.6, р<0.001), total ischemia t-me >180 minutes (OR=4.39; 95 % CI 1.78-10.8, р=0.001). Conclusions. PCIs for STEMI in older age groups were associated with worse in-hospital outcomes. Age, anterior myocardial infarction, Syntax score, ventricular arrhythmias, blood glucose level at admission, PCI failure, Killip class III-IV, total ischemia time >180 minutes were the independent predictor of death.

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Management of Patients With St-Segment Elevation Acute Coronary Syndrome in Interventional Cardiology Units: Record-3 Registry Data

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Early Predictors of Heart Failure Progression in Patients After Myocardial Infarction

Early Predictors of Heart Failure Progression in Patients After Myocardial Infarction

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Percutaneous coronary interventions for ST elevation myocardial infarction in different age groups

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