[A poor outcome prediction scale in ST-segment elevation myocardial infarction patients undergoing emergency percutaneous coronary intervention].

AIM: To make a prediction scale using a set of clinical and laboratory prognostic variables for patients with ST-segment elevation myocardial infarction (STEMI) on their electrocardiograms (ECG) who have undergone percutaneous coronary intervention. SUBJECTS AND METHODS: The study enrolled 154 STEMI patients who had undergone percutaneous coronary angioplasty with stenting of the artery supplying blood to the area of an ischemia. Enzyme immunoassay was used to determine the levels of cytokines and selectins on days 1 and 10. RESULTS: During a year, the authors identified the following independent risk factors of a poor outcome (PO): symptoms of Killip Class III-IV heart failure; a history of smoking; rhythm and conduction disturbances on day 1 of the disease; tumor necrosis factor-alpha levels determined on day 1 of the disease; IL-1alpha and sP-selectin levels measured on day 10. In the made prediction scale, a score was assigned to each independent prognostic variable to estimate the risk of PO. The borderline values of summing the scores, which divided the patients into groups at low, moderate, and high risk for PO, were determined for the practical application of the scale, by using the receiver operating characteristic curve (ROC) analysis. The performance of the model was tested using an independent sample of STEMI patients (n = 50). The probability that the classification of the model was correct amounted to 89.6% (p < 0.0001). CONCLUSION: The made prediction scale allows the patients with STEMI to be allocated to groups at low, moderate, high risks for PO during a year. Evaluation of the prognostic efficiency of the new scale versus the known scales PAMI, CADILLAC, and TIMI ST elevation, by plotting the ROC curve and estimating the area under the latter, demonstrated the high predictive ability of the new scale.

[Clinical and prognostic significance of multifocal atherosclerosis in patients with acute coronary syndromes without ST-segment elevation].

Aim of the study was to determine incidence of multifocal atherosclerosis (MFA), to assess its clinical and prognostic significance in the hospital phase in patients with non-ST elevation acute coronary syndrome (NSTEACS). We studied data from 225 patients with duration of NSTEACS 48 hours or less, who along with usual examination were subjected to coronary angiography and color duplex scanning of extracranial arteries and arteries of lower extremities. As lesions we considered any stenosis irrespective of intima media thickness. MFA was detected in 43.6% of cases. Patients with MFA were older, they more often had history of myocardial infarction, had lower creatinine clearance, and left ventricular ejection fraction. Presence of artery stenoses in 3 vascular regions was associated with multivessel coronary artery disease. Inhospital "endpoints" (myocardial infarction, stroke, death) occurred more frequently in patients with MFA. Patients with lesions in 2 and 3 vascular beds were characterized by maximal Grace score, while those without coronary and peripheral artery involvement- by minimal Grace score. The presence of MFA in patients with NSTEACS was associated with unfavourable course of the disease. Thus ptatients with MFA were characterized by high average rating on Grace scale; involvement of three vascular beds was associated with high mortality.