Russian Acute Coronary Syndrome Registry Research Articles

Missing value imputation with linear methods in the database of cardiological patients in prediction of mortality

This study examines missing value imputation in the Russian Acute Coronary Syndrome Registry (RusACSR) and assessment of the probability of predicting mortality. Linear methods with the most probable or average value were used for imputation. The prediction problem was solved using the k-nearest neighbors method. This work reveals that the imputation method, despite their simplicity, increases the probability of prediction of mortality by 6%.

Application of the Appropriate Use Criteria for Coronary Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation: Data from the Federal Registry.

The aim of the study was to apply the appropriate use criteria (AUC) for coronary revascularization on Russian Acute Coronary Syndrome Registry (RusACSR) data to analyze validity of the decision to perform percutaneous coronary interventions (PCIs) among patients with acute coronary syndrome (ACS). In Russia, the frequency of performing PCI increased almost 7.5 times, and more than half of all interventions were performed in patients with ACS, in the period from 2006 to 2015. AUC 2012 were used to assess PCI appropriateness. Data were exported from RusACSR from a period of January 1, 2016 to December 31, 2016. We analyzed 33 893 cases, but 13 957 patients were excluded owing to absence of data needed. The study group therefore included 19 936 patients with ACS (mean age, 65.3 ± 11.9 years; 40.3% women), and it was divided into 2 subgroups: 13 757 (67.2%) patients who were treated conservatively and 6179 (32.8%) patients who underwent PCI. According to AUC, physicians' choice of strategy was validated. Patients treated conservatively differed significantly (P < .001) from those who underwent PCI. In this group, non-ST segment elevation ACS was significantly more common than in the group of patients who received PCI (84.4% vs. 43.9%, P < .001). They also had more severe clinical status. According to AUC, among patients with ACS treated with PCI, the decision was warranted in 86.3% (valid decision). In 7.6% of cases, there was no need for PCI. Among patients who underwent conservative treatment, 77.7% of patients needed PCI according to AUC. According to our data, only 3.8% of patients who were treated conservatively did not need PCI. Appropriateness of invasive treatment was uncertain in 18.5% and 6.1% in the PCI and non-PCI groups, respectively. All differences were significant (P < .001). AUC implementation showed low availability of PCI for patients with non-ST segment elevation ACS accompanied by complicated clinical status. AUC for coronary revascularization could be applied in Russian clinical practice for unbiased PCI candidate selection and for evaluation of decision validity.

Prevalence of severe hypercholesterolemia in Russian acute coronary syndrome registry

Aim: There are gaps in our knowledge of prevalence, awareness and control of severe hypercholesterolemia (low-density lipoprotein-cholesterol cholesterol (LDL-C) cholesterol > 5.0 mmol/l) in the Russian Federation. Increased cardiovascular morbidity and mortality in Russia is related to high prevalence of hypercholesterolemia and low statin use.

Динамика выполнения рекомендованных лечебных мероприятий у пациентов с острым коронарным синдромом в регионах Российской Федерации за 2014-2015 годы

The article shows the dynamics of healthcare quality measures which were estimated on the basis of clinical cases of acute coronary syndrome (ACS) included in the Russian ACS registry in 2015 and compared with 2014 data.

Objectives and Design of the Russian Acute Coronary Syndrome Registry (RusACSR).

The Russian Acute Coronary Syndrome Registry (RusACSR) is a retrospective, continuous, nationwide, Web-based registry of patients with acute coronary syndromes (ACS). The RusACSR is a database that uses a secure Web-based interface for data entry by individual users. Participation in the RusACSR is voluntary. Any clinical center that provides health care to ACS patients can take part in the RusACSR. The RusACSR enrolls ACS patients who have undergone care in Russian hospitals from February 2008 to the present. Key data elements and methods of data analysis in the RusACSR are presented in this article. Up to 2015, 213 clinical centers from 36 regions of Russia had participated in the RusACSR. Currently, the database contains data on more than 250 000 ACS patients who underwent care from 2008 to 2015. Some current problems are highlighted in this article. The RusACSR is a perspective project for different epidemiologic studies in Russian ACS patients.

Структура первичных элементов базы данных российского регистра больных с острым коронарным синдромом

The article contains the structure of key data elements of the database of the Russian acute coronary syndrome registry.

IMPLEMENTATION OF EVIDENCE-BASED CLINICAL-AND-MORPHOLOGICAL APPROPRIATE USE CRITERIA FOR CORONARY REVASCULARIZATION IN PATIENTS WITH ACUTE CORONARY SYNDROME IN RUSSIA

Aim. To study possibility of using the evidence-based clinical-andmorphological appropriate use criteria for percutaneous coronary interventions (PCIs) for expert evaluation of high-technology procedures implementation in patients with acute coronary syndrome (ACS) in Russia.Materials and methods. The appropriateness of performed PCI was assessed in patients with ACS, underwent coronary revascularization. The potential need in PCI was determined in ACS patients refused from coronary revascularization. Assessment was performed with the help of ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update (ACCF 2012). Data from 65,912 ACS patients, containing in Russian ACS Registry (2010–2011) were examined.Results. ACCF 2012 criteria allow to assess the clinical appropriateness of PCI in 79.2% of patients underwent coronary revascularization and to determine the potential need in PCI in 80.6% of patients, refrained from coronary revascularization. Among ACS patients underwent PCI (n=9147), intervention was appropriate in 68.9% of cases. Inappropriate PCI was revealed in 4.6% of cases. Among patients refrained from PCI (n=56765), coronary revascularization was potentially appropriate in 57.9% of cases.Conclusion. ACCF 2012 clinical-and-morphological criteria allow to judge on appropriateness of performed PCI and to evaluate the potential need in PCI among the most part of Russian ACS patients. In present study coronary revascularization was appropriate in the majority of ACS patients. It was shown possible to use the evidence-based clinical-andmorphological criteria for expert evaluation of high-technology procedures implementation in Russian ACS patients.

Impact of patient-related and treatment-related factors on in-hospital mortality of patients with ST-elevation myocardial infarction: Data of Russian Acute Coronary Syndrome Registry

ObjectiveWe examined relationships between inpatient medical treatment, reperfusion therapy and in-hospital mortality among patients with ST-elevation myocardial infarction (STEMI) in Russia. MethodsClinical information about 25,682 patients with STEMI enrolled in the 2010–2011 registry was included retrospectively in the study. Performance of the key guideline-recommended treatment interventions was assessed. Timeliness of reperfusion therapy was evaluated with the help of the following ACC/AHA clinical measures (2008): Time to fibrinolytic therapy, Time to primary percutaneous coronary intervention (PCI) and Reperfusion therapy. Multivariate logistic and Cox's regression models were used to assess the relationship between different in-hospital treatment interventions and the risk of in-hospital death among patients with STEMI under the control of patient characteristics and comorbidities. ResultsThe average age of patients was 63 (55–74) years. 34% of patients were female. Survived patients differed significantly from deceased ones in the majority of demographic, anamnesis, clinical presentation and treatment parameters. Hospital treatment with ACE-Is or ARBs, β-blockers and statins was significantly associated (χ2=482.1, P<0.0001) with lower inpatient mortality. Prognostic value of reperfusion therapy and measures of its timeliness were not statistically significant (P≥0.05 for Wald test for each factor). ConclusionSTEMI treatment with ACE-Is or ARBs, β-blockers and statins during hospital stay (not necessarily at arrival) influences upon the rate of death in hospital as strong as the patient clinical status at admission. Reperfusion and its performance are additional factors that influence indirectly on the risk of in-hospital mortality in patients with STEMI.

ASSESSMENT OF MYOCARDIAL REPERFUSION QUALITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND ST SEGMENT ELEVATION, BASED ON THE CRITERIA BY THE AMERICAN COLLEGE OF CARDIOLOGY/AMERICAN HEART ASSOCIATION

Aim. To use the criteria by the American College of Cardiology/American Heart Association (ACC/AHA), in order to assess the quality of myocar-dial reperfusion in Russian patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS).Material and methods. We analysed the clinical data of 25682 patients with STE-ACS, who were treated (2010–2011) in Russian hospitals participating in the Russian ACS Registry. The following ACC/AHA indicators (2008) were used: “time to thrombolysis” — the percentage of STE-ACS patients who received thrombolysis within 30 minutes after admission; “time to primary percutaneous coronary intervention (PCI)” — the per-centage of STE-ACS patients in whom primary PCI started within 90 minutes after admission; and “reperfusion” — the percentage of STE-ACS patients who underwent any reperfusion intervention within 12 hours after the chest pain onset.Results. Among 25682 STE-ACS patients, any reperfusion intervention (PCI and/or thrombolysis, in any order) were performed in 12043 (46,9%). Among 7437 STE-ACS patients who underwent thrombolysis, 5119 (69%) met the inclusion criteria. In this group, the indicator “time to thrombolysis” was met in 3342 patients (65,3%). Among 5405 STEACS patients who underwent PCI, 3993 (73,9%) met the inclusion criteria. In these patients, the indicator “time to primary PCI” was met in 2797 (70%). Finally, among 25135 (97,9%) patients with STE-ACS who were included in the analyses, the indicator “reperfusion” was met in 9800 (38,9%).Conclusion. The main problem of the health care for Russian patients with STE-ACS is the limited reperfusion coverage. However, the reperfusion quality could be regarded as satisfactory. 

Factors influencing the implementation of percutaneous coronary interventions in patients with acute coronary syndrome in Russia

Background: It is important to entirely reveal all patients with acute coronary syndrome (ACS) requiring percutaneous coronary interventions (PCI). Peculiarities of decision making in the network of Russian healthcare system were studied. Aim: To identify clinical patient characteristics associated with PCI performance in patient with ACS. Methods: Data from 65,912 ACS patients (60.5% male) aged 63.2±13.8 years, containing in Russian ACS Registry (2010-2011) were examined. Associations between patients' clinical characteristics and PCI implementation were studied among patients who underwent any type of PCI (ACS-PCI patients) and those who were refused PCI (ACS-nonPCI patients). Twenty eight clinical characteristics, including PCI appropriateness according with ACCF 2012 appropriate use criteria, were analyzed using discrimination analysis (multivariate regression). Exposure variable was PCI implementation. Results: PCI was performed in 13.8% of patients. Among ACS-PCI patients PCI was appropriate in 68.9%. Among ACS-nonPCI patients 42.1% of patients were not eligible for PCI because of contraindications and/or ACCF 2012 criteria (procedure was uncertain or inappropriate). Main clinical factors associated with PCI implementation were ACCF 2012 appropriate use criterion No. 1 (STEMI and 12 hours or less from symptom onset), ST-segment elevation on ECG, male sex. In ACS-nonPCI patients, ACCF 2012 appropriate use criterion No. 11 (UA/NSTEMI and high risk features for short-term risk of death or non-fatal MI), the increase in the age and CHF were significantly associated with not receiving PCI. Conclusions: PCI was more commonly performed in patients with unequivocal STEMI compared to high-risk patients with non-ST elevation ACS, although both of these categories of patients had equal need of PCI. Using of ACCF appropriateness criteria allows clinicians to identify more patients requiring PCI and minimizes inappropriate use of the procedures.

THE ORGANIZATION OF MEDICAL CARE FOR ACUTE CORONARY SYNDROME PATIENTS IN PCI CAPABLE AND PCI NON-CAPABLE HOSPITALS FROM 2009-2012

Aim of the study. To evaluate the organization of medical care for acute coronary syndrome (ACS) patients in PCI capable and PCI non-capable hospitals from 2009-2012. Materials. Russian Registry of Acute Coronary Syndromes (ACS Registry) with an internet tracking was created in 2008 year. We performed an observational study of 139 882 ACS patients (56% M, 44% F; av. age - 65 years (56;75) [25%;75%]); ACS with ST elevation pts (ACS STe) - 45 707, ACS non ST elevation pts -84 603. Pts. were hospitalized due to ACS, prospectively enrolled in 167 hospitals from January 2009 to January 2013 in the ongoing ACS Registry. The ACS registry is carried out in cooperation with the Russian Ministry of Health. Results. The majority pts. before ACS had cardiovascular diseases and bad control of arterial hypertension. Many ACS STe pts to correspond for high risk in-hospital and 6-months death (GRACE risk score) (45,4% и 36,7%, accordingly). In 2012 fibrinolysis was used in 30,3% (positive dynamic on 8,3% from 2009). Percutaneous coronary interventions (PCI) for ACS STe pts. were used in 28,2% (primary PCI more than 80% pts). Conclusion. Russian ACS Registry may provide with information concerting characteristics and treatments of ACS pts. in different hospitals from Russia.

Acute coronary syndrome in patients with type 2 diabetes mellitus: analysis of Russian hospital care

Aims. To analyze basic clinical characteristics, inhospital therapeutic approaches and outcomes in patients with acute coronary syndrome(ACS) and diabetes mellitus (DM). Materials and methods. Patients were included in this study according to the protocol, established for Russian ACS Registry (RECORD),based on data from 18 hospitals operating in 13 Russian cities. Results. 796 patients took part in the current study. 15.6% reported diagnosis of DM at admission. We observed positive correlationbetween initial glycemic levels and presence of DM (r=0.43; р