Predictors of increased risk of adverse events coronary heart disease in patients with acute coronary syndrome without persistent ST-elevation

July 6, 2020
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Resume

Aim of study — to develop model for assessing the risk of adverse effects during long-term follow-up after acute coronary syndrome (ACS) without persistent ST-segment elevation, which is based on data from the ACS hospital period, and to assess the informativeness of the developed model. Materials and methods. The analysis of clinical and anamnestic and laboratory data of 490 patients hospitalized with ACS without persistent ST elevation was performed. The duration of observation was 12.16±0.17 months. Using logistic regression analysis, the most significant risk factors for combined endpoint (CE-cardiovascular death, myocardial infarction, unstable angina) during 12 months after ACS were identified. The informativeness of the developed model for risk CE assessment was verified by constructing ROC-curves, and a comparative analysis was performed on the TIMI and GRACE scales using the statistical software package SPSS 17.0. Results. The risk scale for CE in post-MI patients after 12 months of observation included data on history of nitrate intake, TIMI scale, ESR (day 1 hospitalization), the estimated glomerular filtration rate using the CKD-EPI formula (4-factor-model). The developed scale was highly informative: the area under the ROC curve (AUC) for the 4-factor-model was 0.76±0.03 (95% confidence interval (CI) 0.72–0.81), sensitivity 72.2% (95% CI 60.9–81.7), specificity 71.0% (95% CI 65.3–76.3). The 4-factormodel exceeded the informative value of TIMI and GRACE scales when comparing ROC curves. Conclusions. Proposed model are highly reliable tool for assessing the risk of adverse events during 12 months after ACS. Model is informative and can be used in clinical practice to predict patients with a high risk of complications for 12 months and select the optimal treatment strategy.

References:

  • Alexander K.P., Newby L.K., Cannon C.P. et al. (2007) Acute Coronary Care in the Elderly, Part I. Non–ST-Segment–Elevation Acute Coronary Syndromes: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology. Circulation, 115: 2549–2569. DOI: 10.1161/CIRCULATIONAHA.107.182615.
  • Anavekar N.S., McMurray J.J., Velazquez E.J. et al. (2004) Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N. Engl. J. Med., 351: 1285–1295. DOI: 10.1056/NEJMoa041365.
  • Baigent C., Blackwell L., Collins R. et al. (2009) Aspirin in in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomized trials. Lancet, 373: 1849–1860. DOI: 10.1016/S0140-6736(09)60503-1.
  • Cannon C.P., Weintraub W.S., Demopoulos L.A. et al. (2001) Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N. Engl. J. Med., 344: 1879–1887. DOI: 617.278.0145.
  • Daly C., Clemens F., Lopez-Sendon J.L. et al. (2006) The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur. Heart J., 27: 1298–1304. DOI: 10.1093/eurheartj/ehl005.
  • Erikssen G., Liestøl K., Bjørnholt J.V. et al. (2000) Erythrocyte sedimentation rate: a possible marker of atherosclerosis and a strong predictor of coronary heart disease mortality. Eur. Heart J., 21(19): 1614–1620. DOI: 10.1053/euhj.2000.2148.
  • Fintel D.J., Ledley G.S. (2000) Management of patients with non-ST‐segment elevation acute coronary syndromes: Insights from the PURSUIT trial. Clin. Cardiol., 23 (Suppl. 5): V1–V12. DOI: 10.1002/clc.4960230902.
  • Fox K.A.A., Poole-Wilson P.A., Henderson R.A. et al. (2002) Interventional Versus Conservative Treatment for Patients With Unstable Angina or non-ST-elevation Myocardial Infarction: The British Heart Foundation RITA 3 Randomised Trial. Randomized Intervention Trial of Unstable Angina. Lancet, 360(9335): 743–751. DOI: 10.1016/s0140-6736(02)09894-x.
  • Gerber Y., Weston S.A., Enriquez-Sarano M. et al. (2016) Mortality Associated With Heart Failure After Myocardial Infarction: A Contemporary Community Perspective. Circ. Heart Fail., 9(1): e002460. DOI: 10.1161/CIRCHEARTFAILURE.115.002460.
  • James S.K., Roe M.T., Cannon C.P. et al.; PLATO Study Group (2011) Ticagrelor Versus clopidogrel in patients with acute coronary Syndromes intended for non-invasive management: Substudy from prospective randomized PLATelet trial Inhibition and patient Outcome (PLATO) trial. BMJ, 342: d3527. DOI: 10.1136/bmj.d35279.
  • Lewis E.F., Moye L.A., Rouleau J.L. et al. (2003) Predictors of Late Development of Heart Failure in Stable Survivors of Myocardial Infarction: The CARE Study. J. Am. Coll. Cardiol., 42: 1446–1453. DOI: 10.1016/s0735-1097(03)01057-x.
  • Montalescot G., Dallongeville J., Van Belle E. et al. (2007) STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defned by the ESC/ACC defnition (the OPERA registry). Eur. Heart J., 28(12): 1409–1417. DOI: 10.1093/eurheartj/ehm031.
  • Ozlu M.F., Sen N., Karakas M.F. et al. (2012) Erythrocyte sedimentation rate in acute myocardial infarction as a predictor of poor prognosis and impaired reperfusion. Med. Glas. (Zenica), 9(2): 189–197. PMID: 22926349.
  • Roffi M., Patrono C., Collet J.P. et al.; ESC Scientific Document Group (2015) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur. Heart J., 37: 267–315. DOI:10.1093/eurheartj/ehv320.
  • Suwaidi J.A., Reddan D.N., Williams K. et al. (2002) Prognostic implications of abnormalities in renal function in pa- tients with acute coronary syndromes. Circulation, 106: 974–980. DOI: 10.1161/01.cir.0000027560.41358.b3.
  • Wallentin L., Lagerqvist B., Husted S. et al. (2000) Outcome at 1 Year After an Invasive Compared With a Non-Invasive Strategy in Unstable Coronary-Artery Disease: The FRISC II Invasive Randomised Trial. FRISC II Investigators. Fast Revascularisation During Instability in Coronary Artery Disease. Lancet, 356(9223): 9–16. DOI: 10.1016/s0140-6736(00)02427-2.
  • Yusuf S., Zhao F., Mehta S.R. et al. (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N. Engl. J. Med., 345: 494–502. DOI: 10.1056/NEJMoa010746.