ANALYSIS OF THE PROGNOSTIC SIGNIFICANCE OF SHORT-TERM STRATIFICATION SCALES, USED IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST-ELEVATIONAND MYOCARDIAL INFARCTION (STEMI) AFTER PERCUTANEOUS CORONARY INTERVENTION

Abstract

Acute coronary syndrome (ACS) is the most common pathology among cardiovascular diseases. One of the most effective methods of treating this pathology is primary PCI. The management of ACS with ST-segment elevation patients is more dependent on the risk of an adverse outcome developing on the first day of myocardial infarction (MI), which requires early determination of the short-term forecast. The choice of the optimal scales, which is characterized by high prognostic significance, and, as a result, high sensitivity and specificity in patients with PCI, in particular those living in the Republic of Mordovia.
This study included 342 patients with ACS with ST-segment elevation (75.4% n=258 males, 24.6% n=84 females). The average age of these patients was 61.3±9.5 years. The women were significantly older – 65.9±9.96 years of male patients, the average age of which was 59.8±9.04 years. Along with the generally accepted methods of examination, all patients with PCI underwent a questionnaire to assess the degree of risk of developing short-term fatal complications according to scales NCDR CathPCI, CADILLAC, ACEF, Euro Score II и SYNTAX. Number of patients classified as high-risk at admission based on the criteria presented in each scale, revealed a slight variation in the percentage of scale CADILLAC 25,1%, ACEF 24,2%, SYNTAX 21,9% и EuroScore II 20,7%, relatively scale NCDR CathPCI- 7,9%. During the study period, there were 20 patients with fatal outcome who were admitted with the diagnosis of ACS with ST-segment elevation (5.8%) and who underwent PCI. All deaths occurred within the first 10 days of hospitalization of ACS patients. The average age of fatal ACS with ST-segment elevation patients was 70.1±8.45 years (minimum – 55 years, maximum – 82 years), including 13 (65%) female patients (mean age 71.7±10.08 years (range was 64 – 82 years) and 7 (35%) male patients, mean age 67.2±7.61 years (minimum – 55 years, maximum – 76 years). The causes of death in these patients were cardiogenic shock (72%), interventricular septal rupture (5%), pulmonary embolism (15%), and stent thrombosis (8%). When analyzing the sensitivity and specificity of the development of early fatal complications in ACS with ST-segment elevation patients with PCI, we showed high sensitivity and specificity of the SYNTAX scale (Se 1.0 Sp 0.946), EuroScore II ( Se 1.0 Sp 0.833) and CADILLAC ( Se 1.0 Sp 0.756), relative to the scale ACEF ( Se 0.750 Sp 0.676) and NCDR ( Se 0.50 Sp 1.0) .