GRACE Scale Research Articles

Prediction of in-hospital mortality risk for patients with acute ST-elevation myocardial infarction after primary PCI based on predictors selected by GRACE score and two feature selection methods.

Accurate in-hospital mortality prediction following percutaneous coronary intervention (PCI) is crucial for clinical decision-making. Machine Learning (ML) and Data Mining methods have shown promise in improving medical prognosis accuracy. We analyzed a dataset of 4,677 patients from the Regional Vascular Center of Primorsky Regional Clinical Hospital No. 1 in Vladivostok, collected between 2015 and 2021. We utilized Extreme Gradient Boosting, Histogram Gradient Boosting, Light Gradient Boosting, and Stochastic Gradient Boosting for mortality risk prediction after primary PCI in patients with acute ST-elevation myocardial infarction. Model selection was performed using Monte Carlo Cross-validation. Feature selection was enhanced through Recursive Feature Elimination (RFE) and Shapley Additive Explanations (SHAP). We further developed hybrid models using Augmented Grey Wolf Optimizer (AGWO), Bald Eagle Search Optimization (BES), Golden Jackal Optimizer (GJO), and Puma Optimizer (PO), integrating features selected by these methods with the traditional GRACE score. The hybrid models demonstrated superior prediction accuracy. In scenario (1), utilizing GRACE scale features, the Light Gradient Boosting Machine (LGBM) and Extreme Gradient Boosting (XGB) models optimized with BES achieved Recall values of 0.944 and 0.954, respectively. In scenarios (2) and (3), employing SHAP and RFE-selected features, the LGB models attained Recall values of 0.963 and 0.977, while the XGB models achieved 0.978 and 0.99. The study indicates that ML models, particularly the XGB optimized with BES, can outperform the conventional GRACE score in predicting in-hospital mortality. The hybrid models' enhanced accuracy presents a significant step forward in risk assessment for patients post-PCI, offering a potential alternative to existing clinical tools. These findings underscore the potential of ML in optimizing patient care and outcomes in cardiovascular medicine.

Comparison of the quality of logistic regression models and a classification tree in predicting hospital mortality in elderly patients with non-ST-elevation myocardial infarction

Aim. Using the CHAID (Chi Squared Automatic Interaction Detection) method to develop a classification tree for predicting hospital mortality in patients with non-ST-elevation myocardial infarction (non-STEMI) aged 75 years and older and compare the quality of the constructed model with the logistic regression model.Material and methods. A retrospective analysis of the case histories of 119 sequentially enrolled patients aged ≥75 years who were hospitalized in a cardiology department due to non-STEMI in 2020-2021 was carried out. The construction of a predictive model of probability of dying was carried out using the logistic regression method. To assess the impact of various predictors affecting the probability of dying during the of hospitalization period in patients with non-STEMI, a classification tree was developed using the CHAID method. To compare the quality of logistic regression models and the classification tree, the areas under the ROC curve and confidence intervals were estimated.Results. Based on the construction of a binary logistic regression, it was found that the factors increasing hospital mortality were cardiogenic shock (CS): odds ratio (OR) 47.55; 4.00-589.16; p=0.002; new-onset atrial fibrillation: OR 6.45; 1.39-30.42; p=0.018; and the number of points on the GRACE scale: for each increase by 1 point: OR 1.03; 1,00-1,05; p=0.046. Similar data were obtained when analyzing the classification tree: in patients with CS, the predicted mortality was 91.7%. The probability of an unfavorable outcome based on the constructed classification tree was higher than the average in the analyzed sample in persons without CS, 2-3 degree atrioventricular blocks, and pulmonary edema, but with right bundle branch block on the electrocardiogram (25.0%) and in persons without CS and atrioventricular blockages of 2-3 degrees, but with pulmonary edema and a Q wave on the electrocardiogram (50.0%). Both methods of predicting hospital mortality are applicable. There were no statistically significant differences in the quality of both constructed models; the difference in the areas under the ROC curves was 0.043±0.268 with a 95% confidence interval of -0.055-0.141, p=0.387.Conclusion. Both developed methods can be used to determine the probability of dying in a hospital. Currently, the recruitment of patients into a prospective study of a similar design has begun and is continuing, during which validation of the constructed forecasting models is planned.

Comparative Analysis of the Effectiveness of Riskometer Scales in Predicting the Risk of in-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention.

Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods. A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups. Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (<0.3%), medium (0.3-9%), high (9-17%), and very high (>17%) risk groups. The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.

Particularities of the course and treatment of non-ST elevation acute myocardial infarction: data from the REGION-IM registry

Aim. To characterize patients with acute non-ST elevation myocardial infarction (NSTEMI) hospitalized in Russian hospitals, study their anamnestic, demographic and clinical characteristics, treatment features and hospital outcomes, as well as compare data from previous Russian and foreign registries of acute coronary syndrome.Material and methods. Russian Registry of Acute Myocardial Infarction (REGION-IM) is a multicenter prospective observational study. The case report form contains demographic and anamnestic data, as well as the following information about the present MI: timing of symptom onset, first contact with medical personnel and admission to the hospital; data from coronary angiography (CAG) and percutaneous coronary intervention (PCI), therapy, hospitalization outcomes.Results. In total, for the period from November 1, 2020 to June 30, 2023, the study included 3253 patients with STEMI from 73 hospitals (30 vascular surgery departments, 17 of which are equipped with angiographic system, and 43 regional vascular surgery centers) from 45 constituent entities of the Russian Federation. There were 55% of high-risk patients. CAG was performed in 83,73% of patients. In 81%, CAG was performed ≤24 hours from hospitalization. PCI was performed in 62% of patients with NSTEMI. Median onset-to-balloon time was 27 hours [10;77]. The median door-to-balloon time was 5 hours [1;20]. Inhospital mortality was 3%. In the group with CAG, compared with the group without CAG, inhospital mortality was lower (2% and 6%, respectively; p<0,05). In patients with a higher risk according to the GRACE, CRUSADE and ARC-HBR scales, CAG was performed less frequently.Conclusion. In patients with NSTEMI in Russian regions, there is a high frequency of CAG and PCI, including in the early stages. Inhospital mortality is low, especially in the invasive treatment group, and corresponds to data from international registries. In severely ill patients, revascularization is performed less frequently than in low-risk patients. There is room for increasing the prescription rate of modern effective anticoagulants and antiplatelet agents. In general, the quality of treatment for NSTEMI patients has improved in recent years.

Measuring the dynamics of grace at work

ABSTRACT Long studied in religious traditions, grace has also been explored in psychology and in contexts as diverse as marriage counseling, psychotherapy, and anthropology. We establish that most of the Dimensions of Grace Scales (DGS) work well, with some adjustments, in a religiously diverse group of employees from a variety of work organizations. We develop and refine three measures: grace from bosses, grace from co-workers, and respondents’ own grace-giving practice. We establish an initial nomological net for the construct of grace in the workplace, drawing on aspects of the DGS, grace from co-workers, grace from bosses, and grace-giving, along with trait kindness and forgiveness. We identify several relationships between this group of constructs and thriving at work (both vitality and learning), job satisfaction and intent to quit. The model suggests a workplace climate of grace is both life-giving and likely related to organizational performance.

Psychometric evaluation of the bottom-up developed Experiencing Grace Scale

The experience of grace is currently attracting increased empirical interest. Validated instruments to assess aspects of the experience of grace in a secularized context are scarce which limits current psychological research on grace in other than highly religious populations. We present a bottom-up construction of the Experiencing Grace Scale (EGS) and evidence supporting its reliability and validity. Confirmatory factor analysis showed a good fit for the four subscales: Appraising Grace, Giving Grace, Receiving Grace, and Divine Grace. Reliability analysis showed overall good internal consistency and test–retest stability. Convergent validity was demonstrated by means of expected associations between subscales of the EGS and other relevant measures. Predictive validity was confirmed by associations between subscales of the EGS at measurement Wave 1 with mental well-being scales at Wave 2. The EGS contributes to further research on the experience of grace and its relationship to other psychosocial variables in the field of positive psychology.

Hospital and long-term periods of myocardial infarction in comorbid men and women under 60 years

Aim of the study was to assess the impact of comorbidity on the hospital and 2-year stage of treatment for myocardial infarction (MI) in men and women under 60 years of age.Material and methods. The analysis included 350 patients with MI younger than 60 years of age. The majority of patients (87.4 %) were men. For all patients, the risk was calculated according to the GRACE ASC Risk Model scale and an analysis was made of the severity of comorbidity according to the own model “K9” (patent RU2734993C1 from October 27, 2020), based on the summation of 9 diseases: diabetes mellitus, atrial fibrillation, stroke, arterial hypertension, obesity, peripheral atherosclerosis, thrombocytopenia, anemia, chronic kidney disease.Results. Comorbidity (the presence of 2 or more diseases) was recorded insignificantly more often in men (65.9 % versus 53.6 %, p = 0.12). In men, but not in women, comorbidity was associated with a 23.5 % reduction in percutaneous coronary intervention (p = 0.006). Both in-hospital mortality and the risk of major cardiovascular events (death/MI/stroke) 2 years after discharge were minimal (up to 0.7 % and up to 8.1 %, respectively) in the absence of comorbidity in both men and women, higher in comorbid women (3.4 and 12.5 %, respectively) and maximum in comorbid men (6.1 and 18.4 %, respectively). Comorbidity more significantly aggravated the 2-year prognosis in patients undergoing percutaneous coronary intervention than in receiving primary conservative treatment, increasing the risk of developing the death/MI/stroke end point by 3 times (16.7 and 5.8 %, respectively, p = 0.013). The addition of comorbidity data to the GRACE scale in the Cox regression analysis can significantly improve the prognosis of the onset of the 2-year endpoint, increasing the χ2 value from 64.08 to 79.86, and the value of the area under the ROC-curve (AUC) to 0.79 (95 % confidence interval (95 % CI) 0.71–0.88). At the same time, ROC analysis showed that the modified GRACE scale predicts the onset of the death/ MI/stroke endpoint in men much better than in women: AUC 0.81 (95 % CI 0.72–0.90) and AUC 0.67 (95 % CI 0.51–0.83), respectively.Conclusions. Comorbidity is comparable to the GRACE scale and effectively predicts the likelihood of hospital mortality. At the same time, the GRACE scale has an unsatisfactory predictive value for the 2-year endpoint “death/MI/stroke”. Modification of the GRACE scale with data on comorbidity has important clinical implications in men, but not in women, allowing more effective stratification of the risk of adverse events in the long term after myocardial infarction.

Analysis of growth differentiation factor-15 at the hospital stage of treatment of patients with acute myocardial infarction

Objective: to dynamically study the clinical characteristics, the level of growth differentiation factor 15 (GDF-15) during hospital treatment in patients with acute ST-segment elevation myocardial infarction (STEMI). Materials and methods: an analysis of clinical and laboratory data of STEMI patients during hospital treatment and echocardiography parameters was carried out. Scores were calculated on the GRACE scale to assess the prognosis of in-hospital mortality of patients. The characteristics of patients with STEMI were identified taking into account GDF-15 values. Statistical processing using the statistical software package "Statistica 10.0 for Windows". Results: clinical and laboratory characteristics of STEMI patients on the first day of the disease determined the prognosis. GDF-15 values increased on the first day of STEMI development and depended on the risk of in-hospital mortality on the GRACE scale. GDF-15 values tended to decrease during the inpatient phase of treatment. Patients with STEMI with a GDF-15 concentration equal to or more than 1200 ng/ml did not reach reference values in the dynamics of hospital treatment and had higher values of markers of myocardial necrosis, reflecting the impact on the prognosis. Conclusion: the GDF-15 indicator can be used as a marker for the prognosis of STEMI in combination with the GRACE scale assessment. High GDF-15 values during the hospital phase of patient treatment reflect the prognosis of STEMI patients.

Is grace amazing or old wine in a new bottle? Psychometric development of the Perceptions and Experiences of Grace Scale (PEGS).

Is grace amazing or old wine in a new bottle? Psychometric development of the Perceptions and Experiences of Grace Scale (PEGS).

Prediction of in-hospital mortality in patients with ST-segment elevation acute myocardial infarction after percutaneous coronary intervention

Aim. Development of models for predicting in-hospital mortality (IHM) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) based on multivariate logistic regression (MLR).Material and methods. This retrospective cohort study of 4735 electronic health records of patients (3249 men and 1486 women) with STEMI aged 26 to 93 years with a median of 63 years who underwent PCI was performed. Two groups of persons were identified, the first of which consisted of 321 (6,8%) patients who died in the hospital, while the second — 4413 (93,2%) patients with a favorable PCI outcome. To develop predictive models, univariate logistic regression (ULR) and MLR were used. Model accuracy was assessed using 3 following metrics: area under the ROC curve (AUC), sensitivity, and specificity. The end point was represented by the IHM score in STEMI patients after PCI.Results. Statistical analysis made it possible to identify factors that are linearly associated with IHM. ULR was used to determine their weight coefficients characterizing the predictive potential. IHM predictive algorithms based on GRACE scale predictors, represented both by ULR model and by 5 factors in continuous MLR model, had acceptable predictive accuracy (AUC — 0,83 and 0,86, respectively). The MLR model had the best quality metrics, the structure of which, in addition to 5 GRACE factors, included left ventricular ejection fraction (LVEF) parameters and white blood cell (WBC) count (AUC — 0,93, sensitivity — 0,87, specificity — 0,86) . The greatest contribution to endpoint was associated with the Killip class and LVEF, and the smallest contribution was associated with WBC and the age of patients.Conclusion. The predictive accuracy of the developed MLR models was higher than that of the GRACE score. The model with the structure represented by 5 fac­tors GRACE, LV EF and WBC had the highest quality metrics.

Predictors of pacemaker implantation in patients with myocardial infarction and heart block

The aim of the study was to identify predictors of early and delayed pacemaker (PM) implantation in patients with myocardial infarction (MI) and heart block, allowing the development of models for predicting the feasibility of its implantation.Methods. A randomized selection method was used to form a cohort of patients with MI complicated by cardiac conduction disorders. The first (control) group included 72 patients who did not have a PM implanted, the second (n=46) and third (n=68) groups consisted of patients with MI, having, respectively, indications for early (in the acute period of MI) and delayed (average after 3 years) PM implantation. All patients underwent endovascular revascularization of the infarct-dependent artery during hospitalization. Demographic, clinical, and morphological predictors of PM implantation in patients of the second and third groups were evaluated in comparison with the control group. Multiple logistic regression was used to identify factors associated with the need for PM implantation in the short term (hospital period) and in the long-term period.Results. Factors that determine the expediency of a permanent PM in the acute period of MI at the hospital stage, delayed pacemaker implantation 3.2±1.9 years after myocardial infarction, as well as predictors that do not require a permanent PM throughout the entire observation period, were identified. The main factors that require permanent PM implantation in the acute period were identified: 3rd degree atrioventricular (AV) block in NSTEMI, GRACE score 96 or higher, development of 3rd degree AV block in MI of any localization except postero-inferior. Predictors for the need for PM implantation after 3.2±1.9 years (delayed period) were STEMI of anterior localization; at the same time, age had an inversely proportional relationship in predicting the fact of permanent pacing. The factors that determine the need for PM implantation are the presence of anterior MI, the multiple coronary artery lesions.Conclusion. In the acute (hospital) period of NSTEMI, PM implantation is indicated at a high risk of adverse cardiovascular complications (GRACE scale of 96 points and above), in the presence of the 3rd degree AV block in any MI localization, except for the inferior one. Indications for permanent pacing 3.2±1.9 years after an acute coronary event are STEMI of anterior localization and multiple coronary artery lesions.

Seх differences in treatment of acute coronary syndrome patients. Data from federal registry of acute coronary syndrome 2016-2019

Management of patients with acute coronary syndrome (ACS) is usually universal, regardless of gender, age, and ethnicity. But often in practice, gender and age influence medical decisions, and patients do not receive proper medical care. Medical care for patients with ACS was analyzed by gender according to the federal register of ACS data. To analyze the influence of the patient's gender on the course of the disease and on the provision of medical care to patients with ACS who underwent treatment in 20162019. The data of 95 586 cases was analyzed. Two groups were identified: men (n=59 442, 62.2%) and women (n=36 144, 57.8%). Anamnesis analysis has revealed, that women were often more burdened with concomitant diseases and had a higher risk on the GRACE scale at admission. It was demonstrated that men underwent revascularization on average significantly more often than women (51.9% versus 32.5%, respectively, p0.001). In women, conservative therapy was more. When compared with the appropriate use criteria for coronary revascularization, it was shown that more than 70% of women in whom a conservative treatment strategy was chosen, it was expedient to undergo myocardial revascularization using percutaneous coronary intervention. Gender differences were revealed in the course of the disease, as well as in the choice of treatment by doctors. Women are characterized by a later manifestation of the disease, more often in the form of ST-ACS. The course of the disease in women is associated with a higher comorbidity, atypical symptoms and later call for help. A conservative approach prevails in the choice of ACS treatment tactics in women.

Supplemental Material for Is Grace Amazing or Old Wine in a New Bottle? Psychometric Development of the Perceptions and Experiences of Grace Scale (PEGS)

Supplemental Material for Is Grace Amazing or Old Wine in a New Bottle? Psychometric Development of the Perceptions and Experiences of Grace Scale (PEGS)

An artificial intelligence model to predict 12-month mortality among patients with myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background Ischemic heart disease and acute myocardial infarction (AMI) are the number one causes of death and disability, affecting around 126 million individuals worldwide [1]. About 30% of all cases of AMI lead to death. According to different sources, 8-20% of people with AMI die within 1 year of the event, and every second patient is rehospitalized [1-2]. Thus, it is necessary to assess the risk and to predict the outcomes during the first admission to the hospital, in order to guide the management and treatment after AMI [2]. Conventional risk rating scales and methods have a lot of drawbacks, so novel approaches such as artificial intelligence (AI) and deep learning (DL) methods have the potential to provide an accurate risk assessment and share decision-making in patients who experienced AMI [3-4]. Purpose To develop and validate a deep-learning-based risk stratification model to predict the 12-months mortality in patients with AMI. Methods A cohort of 250 AMI patients with Killip class I-IV was enrolled in the study. The data was collected on the admission day and a year after the event and included anamnesis as well as the results of the physical and laboratory-instrumental examination (72 values). All patients were randomly divided into 2 groups: the derivation cohort, which consisted of 215 individuals, and the validation cohort consisted of 35 patients. Our model was created using the Python programming language in GoogleColab and it is a convolutional neural network (CNN) with 1 input layer, 4 hidden layers, and 1 output layer consisting of neurons with a sigmoid activation function (Fig. 1). We used MaxAbsScaler for data normalization and Adam for optimization. Also, we calculated the GRACE risk score and compared the performance of the models only for the validation cohort that was not used for the model development. Results We developed our DL-based model using the derivation data during the 30 cycles of work, receiving the maximum value of training accuracy of 96.7%. The mortality risk, calculated by our model for the validation group was compared with real 12-months mortality, and the CNN "lied" only 2 times (Table 1). The test of the validation cohort showed such results of our DL-based model: 94% - accuracy, 71% - sensitivity, 100% - specificity, 100% - positive, and 93% - negative prognostic value. These results significantly outperformed the GRACE scale, which showed 63%, 71%, 54%, 26%, and 94% respectively. Conclusions In summary, we develop and validate a DL-based risk stratification model to predict the 12-months mortality in patients with AMI. The accuracy of the created model is significantly higher than conventional risk scales (GRACE score). Thus, it is proved that algorithms based on deep learning may be more effective to predict mortality and guide the management of cardiac patients.

The Advantages of Dual Antiplatelet Therapy Combinations in Predicting Recurrent Cardiovascular Events in Obese Patients after Myocardial Infarction

The purpose of the study was to analyze the incidence of recurrent cardiovascular events in obese patients after a myocardial infarction during a 6-month follow-up period, depending on the combination of ticagrelor or clopidogrel with acetylsalicylic acid as a part of dual antiplatelet therapy. Materials and methods. The study involved 75 patients with acute myocardial infarction with ST segment elevation and concomitant obesity. The patients were divided into 2 subgroups: the first included 31 patients who received the combination of acetylsalicylic acid and ticaglelor, and the second – 44 patients treated with the combination of acetylsalicylic acid and clopidogrel in dual antiplatelet therapy. The GRACE scale was used to stratify the risk of hospital and 6-month mortality. Control of the recurrent cardiovascular events presence was carried out after 6 months. Results and discussion. Acute myocardial infarction with ST elevation is still the main cause of mortality and invalidisation of able-bodied population. Regardless of the primary percutaneous coronary intervention or thrombolysis, dual antiplatelet therapy remains the main therapeutic strategy, both in the acute ST-elevation myocardial infarction period and in the remote – for the secondary prevention of possible adverse cardiovascular events, and is a combination of acetylsalicylic acid and a P2Y12 receptor inhibitor. To date, the issue of the choice of a P2Y12 receptor inhibitor in the dual antiplatelet therapy that is used in the treatment of ST-elevation myocardial infarction is an urgent subject of scientific discussion. While observing patients after a myocardial infarction with concomitant obesity over a period of 6 months, it was found that 28 patients had a recurrent myocardial infarction and / or unstable angina, which was 37.56% of all patients. The analysis of the GRACE scale scores in a cohort of patients with recurrent cardiovascular events revealed that all patients were included in high risk group (> 118 points). In the group of patients who received dual antiplatelet therapy with the involvement of acetylsalicylic acid and ticagrelor in 11 people recorded a repeated myocardial infarction and / or unstable angina, which was 14.76%. At the same time, in a group of patients receiving dual antiplatelet therapy in a combination of acetylsalicylic acid with clopidogrel, re-cardiovascular catastrophes were detected in 17 patients, which was 22.8% of all patients with ST-elevation myocardial infarction on the background of concomitant obesity. Conclusion. The patients with obesity after a myocardial infarction who are included in the GRACE high risk group are recommended to be treated with the combination of acetylsalicylic acid and ticagrelor as a result of a notable reduction in the risk of recurrent cardiovascular catastrophes compared with the combination of acetylsalicylic acid and clopidogrel

Clinical and biochemical parameters in patients with acute heart failure secondary to myocardial infarction

Objective: to study the clinical features, dynamics of the NTproBNP level in patients with STEMI, taking into account the risk of hospital mortality scales. Materials and methods: the study included 150 patients with STEMI. All patients were divided into subgroups: according to the GRACE scale (low, medium and high risk) and the degree of acute heart failure (AHF) classification T.Killip II and III-IV. The clinical and laboratory characteristics of patients, including the level of NTproBNP, were studied. Results: the average age of STEMI patients was 61.7±2.96 years. Dyslipidemia, increased level of markers of myocardial necrosis, high concentration of NTproBNP without tendencies to changes in the dynamics of hospital treatment were detected on the first day of STEMI. Patients with STEMI of Killip III-IV had a statistically significant NTproBNP level 2.0 times higher (p<0.05), and at discharge 2.1 times (p<0.05) compared with the group of patients with Killip II. It should be noted that during hospital treatment, the values of NTproBNP did not change statistically significantly regardless of the degree of T.Killip AHF (p>0.05). A high level of NTproBNP was obtained on the first day of the STEMI in all risk groups of hospital mortality on the GRACE scale. A tendency to increase the values of NTproBNP (p<0.05) with an increase in the risk of hospital mortality was revealed. Conclusion: patients with STEMI AHF Killip III-IV have a greater volume of myocardial damage and the level of NTproBNP, determining a high risk of heart failure. NTproBNP values progressively increase with increasing GRACE scale risk and will not change during inpatient treatment.

РАННИЕ И ОТДАЛЕННЫЕ КЛИНИЧЕСКИЕ ИСХОДЫ У ПАЦИЕНТОВ С НЕСТАБИЛЬНОЙ СТЕНОКАРДИЕЙ И СТЕНТИРОВАНИЕМ КОРОНАРНЫХ АРТЕРИЙ

Aim. To study early and long-term clinical outcomes in patients with unstable angina (UA) and coronary artery stenting based on the results of a seven-year follow-up. Materials and Methods. The study included 165 patients with UA and coronary artery stenting. The average age of patients was 59.04±10.34 years; the number of male patients was 129 (78.2%). The risk by the GRACE scale was 96.9±17.46 points. The average number of affected coronary arteries was 2.23±1.07 per person, the average number of implanted stents was 2.10±1.45 per person, the average length of the stented area was 43.12±25.6 mm. Everolimus- or sirolimus-eluting stents were used. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein; platelet, plasma, and vascular hemostasis were evaluated. The patients underwent echocardiography, coronary angiography. The follow-up period was 7±1.6 years. Results. During a 7-year follow-up period, with endovascular treatment strategy and double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg repeated UA developed in 91 (55.2%) pts and myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent stent thrombosis risk predictors included AUC ADR test ≥ 77.5 U, troponin I ≥ 0.90 ng/ml, total length of the stented area ≥ 60 mm. Independent predictors of the development of restenosis/neoatherosclerosis included: more than 4 implanted stents per patient (RR 1.440; 95% CI 1.233-1.681), the total length of the stented area ≥ 60 mm (RR 1.532; 95% CI 1.245-1.884), homocysteine ≥ 14 µmol/l (RR 1.479; 95% CI 1.168-1.876), myeloperoxidase ≥ 300 pmol/l (RR 1.351; 95% CI 1.102-1.656), with risk factors including a history of coronary heart disease for more than 5 years (RR 13.011; 95% CI 4.226-40.050), diabetes mellitus (RR 1.367; 95% CI 1.136-1.647). Conclusion. The number of early and long-term coronary events in patients with unstable angina and coronary artery stenting was estimated. Predictors of stent thrombosis, restenosis and the formation of new atherosclerotic plaques outside the stenting zone were identified.

Optimal periods for coronary artery bypass surgery on working heart in patients with stenosis of left main coronary artery and acute coronary syndrome

Introduction: The treatment strategies of patients with stenosis of the left main coronary artery (LMCA) and acute coronary syndrome (ACS) is being debated. One of the key problems is the selection of the optimal time for coronary artery bypass surgery (CABS) in these patients.
 Aim: To analyze different periods of revascularization of the myocardium by CABS on a working heart in patients with LMCA stenosis and ACS.
 Materials and methods: A prospective analysis of treatment of 112 patients with LMCA stenosis ( 50%) and ACS was performed. Patients were divided to three groups depending on the time of surgical treatment: upto 7 days after occurrence of ACS, 18 (16.1%, group1) patients; 814 days, 38 (33.9%, group2) patients; 14 days, 56 (50%, group3) patients. The average time of ACS-CABS in all patients was 15 days. The groups were comparable in terms of the main preoperative parameters, except for EuroSCORE II and GRACE scale that were predominant in the early periods of CABS.
 Results: LMCA subocclusion (stenosis 90%) with coexistence of anginal syndrome at rest was observed in more than half of patients with surgery upto 7 days (56%, p=0.019). The surgery duration, blood loss through drains, number of days in the resuscitation unit, duration of artificial lung ventilation, and use of vasopressor support were not significantly different. The revascularization index was higher in surgeries conducted within 7 days than in surgeries performed within 814 days (2.33 0.59 versus 1.89 0.65, p=0.02). The evaluation of the dynamics of the functional parameters of the myocardium showed a greater increase in ejection fraction in group1 when compared with group3 after surgery (p=0.036). In the evaluation of the end-diastolic volume of the left ventricle, the average reductions were 16 mL, 14 mL, and 8.5 mL, respectively, without any significant differences among the groups. The rate of intrahospital lethality was highest in group3 (.4%), followed by group2 (2.6%). No fatal outcomes were noted in surgeries conducted in upto 7 days (p 0.050).
 Conclusion: Early CABS performed upto 7 days have similar immediate results to delayed ones and considerably improves the contractile ability of the myocardium in patients with ACS and LMCA stenosis.

Estimation of metformin and other sugar reducing therapy influence on the outcomes in patients with acute coronary syndrome and diabetes mellitus type II

Aim. To study the influence of hypoglycemic therapy on hospital and long-term prognosis in patients with acute coronary syndrome (ACS) and diabetes type 2.Methods. The study included 63 patients with ACS and type 2 diabetes. All patients had a clinical examination, assessment of mortality risk and myocardial infarction on GRACE scale (Global Registry of Acute Coronary Events) and TIMI (Thrombolisis In Myocardial Infarction) in-hospital and six months after hospitalization.Results. Metformin is associated with a lower estimated risk of in-hospital mortality and within 6 months after discharge in patients with acute coronary syndrome on the background of type 2 diabetes and with less risk of adverse cardiovascular events within 14 days of their occurrence in patients with unstable angina pectoris on the background of diabetes. High daily doses of metformin have also been associated with a decrease in the estimated risk of in-hospital mortality and within 6 months after discharge in patients with ACS associated with diabetes. The inverse association between the daily dosage of metformin and the presence of angina pectoris in patients with ACS and diabetes type 2 indicates a protective effect of metformin high daily dosages in relation to the risk of complications within six months after the discharge from hospital.Conclusion. One of the important aspects of ACS treatment, along with effective therapy, is the impact on concomitant risk factors, including blood glucose control. The main groups of hypoglycemic drugs have currently been identified; their effect on cardiovascular events, long-term effects and long-term prognosis are being investigated.

Acute coronary syndrome in patients with cancer: features of the course and the possibility of predicting hospital and long-term (6 months) periods using GDF-15, NT-proBNP, hs-CRP biomarkers.

Aim To evaluate clinical features of the course of acute coronary syndrome (ACS) in patients with oncological diseases (OD) and to determine the role of biomarkers GDF-15, NT-proBNP, and hs-CRP in short-term and long-term prognoses.Material and methods In 88 patients (34 patients with ACS and OD and 54 patients with ACS without OD), complaints and historical, objective, and laboratory and instrumental data were evaluated and blood concentrations of GDF-15, NT-proBNP, and hs-CRP biomarkers were measured on the first day of hospitalization. Incidence of cardiovascular complications (CVC) and outcomes of hospital and long-term (6 months) periods were analyzed. Statistical analysis of results was performed with the Statistica 12.0, MedCalc 19.1.7 software. The level of statistical significance was р<0.05.Results In the ACS+OD group as compared to the ACS without OD group, the onset of disease was mostly atypical, with shortness of breath and/or general weakness; the ACS+OD patients more frequently had III-IV Killip class acute heart failure (29 and 7 %, р=0.01); mean hemoglobin concentration (125.6±27.9 and 141±16.6 g/l, р=0.003), prothrombin index (76.4±15.2 and 84.9±17.6 %, р=0.003), and left ventricular ejection fraction (47.7±6.1 and 50.7±7.2 %, р=0.02) were lower; and median concentrations of GDF-15 (1.95 [1.3; 2.8] and 1.45 [1.2; 2.0] ng/ml, р=0.03), NT-proBNP (947.3 [517.8; 1598.2], and 491.1 [85.1; 1069.1] pg/ml, р=0.006), and hs-CRP (14.1 [8.15; 36.75] and 7.8 [4.4; 16.2] mg/l, р=0.01) were higher. The presence of OD was associated with development of CVC, including urgent endpoints in the long-term and also increased the probability of fatal outcome within 6 months after discharge from the hospital. To predict the risk of CVC in patients with ACS and OD, two models with high prognostic values (AUC>0.9) were proposed. In the long-term, the value of NT-proBNP (cut-off point >524.5 pg/ml) was a statistically significant predictor for development of endpoints with a high predictive value (AUC>0.8).Conclusion The features of the clinical course of ACS in patients with OD indicate the importance of isolating such patients into a separate group. Additional use of the developed models, along with a standard risk assessment by the GRACE scale, will allow individualized management of patients with ACS and OD during the hospital and long-term (6 months) periods.