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