THE PROGNOSTIC UTILITY OF LEUKOCYTE AND PLATELET COUNTS FOR RISK ASSESSMENT OF IN-HOSPITAL COMPLICATIONS IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION.

OBJECTIVE: The aim: We have aimed to develop method of risk assessment in patients with acute STEMI using blood cells count useful in everyday clinical practice. PATIENTS AND METHODS: Materials and methods: 317 STEMI patients admitted to ICCU starting at 01/2014 to 06/2020 were included in this study. Data were evaluated partially retrospectively (n=214), 1st group) and prospectively, applying new risk-assessment tool in 103 patients 2nd group). Study groups did not differ in terms of all clinical characteristics. RESULTS: Results: To evaluate criteria of severity of in-hospital complication we have created in-hospital complication index (HCI), composed according to number of adverse events per patient. Based on correlation analyses we have composed complex WBC-platelets (WBC-PLT) index = ((GRA - MON) / LYM) · 10 + PDWc + P-LCR). In the 1st study group WBC-PLT index was associated with in-hospital complications' index and correlated with neutrophil-leukocytes ratio (NLR) (p<0,001 and p<0,0005 respectively). WBC-PLT index > 137 appeared to be mildly associated with increased risk of adverse in-hospital outcomes (with specificity of 78 % and low sensitivity of 64 %, AUC- 0,72). Further prospective study of WBC-PLT index measured on the first STEMI-day (group 2) revealed that this parameter was more informative regarding association with adverse in-hospital events whereas NLR had low accuracy in risk assessment. CONCLUSION: Conclusions: WBC-PLT index assessed on the first STEMI day may be used as a tool for detection of patients at risk of adverse in-hospital events in the every-day clinical practice.

Treatment and outcomes of eastern Europeans with coronary syndromes in OPUS-TIMI 16.

BACKGROUND: Registries and clinical trials have offered limited evidence on the translation of acute coronary syndrome trial findings into local practices in Eastern Europe. We examined differences in acute coronary syndrome treatment and outcomes between Eastern Europe and other regions in OPUS TIMI-16, a multinational trial of oral glycoprotein IIb/IIIa inhibition for ST-segment and non-ST-segment elevation acute coronary syndromes conducted between 1997 and 1999. METHODS AND RESULTS: We compared variation in baseline characteristics, adjunctive treatment, and outcomes of patients in Eastern Europe and other regions of the world. We found that during this period, Eastern European sites made significantly more use of medications for coronary prevention before and after hospitalization. These sites, however, also made less use of adjunctive medications during their hospitalization. Fewer Eastern European patients received lipid-lowering medication both prior to admission and following discharge. Eastern European patients also underwent fewer percutaneous coronary interventions. Patients in Eastern Europe had worse outcomes at 30 days and at 10 months. CONCLUSION: This study revealed disparities in the use of medical treatments and percutaneous coronary interventions between Eastern European sites and trial sites in other countries. These findings indicate the need for studies to address the sources of treatment and outcome variation. The underuse of effective treatment modalities in all regions calls for strategies to improve access to cardiovascular therapies.

Unfortunate impact of age on the management and outcomes of unstable angina and non-ST elevation myocardial infarction (The GUARANTEE Registry).

Few data are available from the registries on the impact of age and gender on treatment and outcomes of patients admitted for unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI). We examined the clinical characteristics, differences in management and outcomes, associated with age in 2948 consecutive patients with UA/NSTEMI. Prospectively collected data from the Global Unstable Angina Registry and Treatment Evaluation (GUARANTEE) registry were analyzed, comparing patients older than 75 years of age and those 75 years and younger. Patients presenting at a younger age, both men and women, were more likely to have a family history of coronary artery disease, to be current smokers, and to have hypercholesterolemia (P < 0.001). Older patients more commonly had a prior history of stroke, angina, myocardial infarction (MI), and congestive heart failure (P < 0.05), and had more diffuse disease on angiography (P < 0.001). Although older women more often "ruled-in" for MI on admission, they were less likely to be cared for by a cardiologist (P < 0.05). A gradient in the use of cardiac catheterization was seen, with greatest use in younger men, 54.2% versus 47.4% for younger women, 43.1% for older men, and the lowest use in older women, 34.5% (P < 0.01). An opposite gradient of in-hospital mortality was seen, with 0.7%, 0.7%, 0.9%, and 3.2% across the 4 groups, respectively, with older women having worse outcomes (P = 0.008). Unfortunately, a "reverse targeting" of procedures to patient risk was seen among elderly, even when stratified by gender, with older patients being higher risk, but less likely to receive appropriate procedures. To improve the outcomes of elderly men and women with UA/NSTEMI, they should be managed more aggressively.