Abstract
to study the role of clinical factors and treatment tactics in the development of adverse outcomes in patients with non-STelevation acute coronary syndrome (NSTEACS) for five years follow up. The study included 415 patients with NSTEACS observed for 60±4 months from the date of discharge. Adverse events (AE) were unstable angina (UA), myocardial infarction (MI), ischemic stroke or patient's death. The favorable 5-year outcome was identified in 200, adverse outcome - in 178 patients. Statistical processing was performed using STATISTICA 8.0 software package and MedCalc 11.0. Total mortality for 60 months was 16.1% (n=61). Highest mortality, maximal number of hospitalizations due to MI (41.1%) and UA (49.6%) were observed during first 12 months. Greatest impact on the development of AE produced: history of MI, higher GRACE score, age >54 years (p=0.0021), stenosis in brachiocephalic arteries, ischemic changes on admission ECG and reduced left ventricular ejection fraction (LVEF) ≤ 52% (p=0.0001). Five-year survival rate was influenced by coronary angiography (p=0.0001) and percutaneous coronary intervention (PCI) during index hospitalization (p=0.0039). Mortality and frequency of AE in this register were close to generally reported. The observed adverse impact on the long-term outcome of such risk factors such as age over 60 years, history of MI, ischemic ECG changes at admission, decreased LVEF corresponded to literature data. Our study proved the need for coronary imaging in patients with NSTEACS to determine treatment strategy in in hospital period as these factors affected the 5-year survival. During five-year follow-up AE occurred in 47.1% of patients with NSTEACS. Maximal number of patients with AE was registered during the first (24.7%) and fifth (13.8%) year of observation. The development of AE was associated with older age, history of MI and coronary artery bypass grafting, ischemic ECG changes, decreased LVEF, higher GRACE score, and brachiocephalic artery stenosis. Carrying out diagnostic coronary angiography and PCI with stenting during hospitalization in patients with NSTEACS was associated with favorable 5-year outcome.
Highlights
Наиболее распространенной причиной госпитализации пациентов с ишемической болезнью сердца (ИБС) является острый коронарный синдром (ОКС), причем в большей степени – ОКС без подъема сегмента ST (ОКСбпST) [1]
§ ОСТРЫЙ КОРОНАРНЫЙ СИНДРОМ with non-STelevation acute coronary syndrome (NSTEACS) observed for 60±4 months from the date of discharge
Five-year survival rate was influenced by coronary angiography (p=0.0001) and percutaneous coronary intervention (PCI) during index hospitalization (p=0.0039)
Summary
Данные представлены в виде абсолютного числа (%). * – смерть на госпитальном этапе. ССЗ – сердечно-сосудистые заболевания. Максимальное число госпитализаций по поводу ИМ (41,1 %) и НС (49,6 %) были отмечены в течение первых 12 мес, в то время как наибольшее число ОНМК – в течение 5‐го года наблюдения. По результатам проведенного анализа пациенты с наличием КТ были достоверно старше, чаще имели постинфарктный кардиосклероз (ПИКС) и КШ в анамнезе, более высокую оценку по шкале GRACE при поступлении в стационар по сравнению с пациентами, характеризующимися благоприятным исходом. С помощью ROC-анализа определено пороговое значение возраста, после которого увеличивается риск развития НИ у больных с ОКСбпST >54 лет (р=0,0021; AUC=0,589). Что такие анамнестические факторы, как сахарный диабет (СД) 2‐го типа, ОНМК, стенокардия, хроническая сердечная недостаточность (ХСН), артериальная гипертензия (АГ), а также фибрилляция предсердий (ФП) / трепетание предсердий (ТП) встречались статистически незначимо чаще среди пациентов с наличием НИ по сравнению с пациентами с благоприятным течением периода наблюдения. Исходная клинико-анамнестическая характеристика пациентов с ОКСбпST в зависимости от 5‐летнего прогноза
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