Diagnostic value of clinical-instrumental and hematological indicators in predicting complications of the hospital period of STEMI in conditions of chronic stress caused by wartime

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O. V. Shumakov
O. M. Parkhomenko
Ya. M. Lutay
D. V. Khomiakov


The aim – to develop a diagnostic system that takes into account the peculiarities of clinical, instrumental and laboratory indicators in patients with STEMI against the background of wartime and will allow to objectify a tendency to a more difficult hospital course of ACS.
Materials and methods. We studied a cohort of patients (n=133 individuals, 77.4 % men, average age 61.8±0.9 years) with STEMI, part of which (group 1) was hospitalized from February to May 2019 (n=87), while another part of which (group 2) was hospitalized in the period from February 24, 2022 to March 2023 (n=46) within the first 24 hours from the development of symptoms of the disease (average time of admission 5.2±0.4 hours). The groups were compared according to the clinical and anamnestic and laboratory parameters of the first day.
Results and discussion. It was found that in the Ukrainian population during wartime, patients with STEMI are admitted to the hospital later, have a more burdensome history of cerebrovascular diseases, a greater number of significant coronary stenoses, a higher percentage of smokers, and also have higher heart rate levels upon admission, ESR, triglycerides, leukocytes (at the expense of lymphocytes and monocytes), as well as platelets (with lower indicators of their size inhomogeneity). Also, invasive treatment of these lesions leads to slightly worse results on the TIMI and MBG scales. Informativeness of hematology analysis indicators and other markers of inflammation/stress on the first day of STEMI in wartime was evaluated for predicting the risk of an complicated course of the hospital period (development of cardiac death, signs of LVEF, ventricular tachyarrhythmias, stent thrombosis, acute renal dysfunction, recurrence of ACS/angina). It was found that predictors of the undesirable course of STEMI during wartime are: heart rate > 70/min, ESR > 10 mm/h, glucose level > 8.5 mmol/l, leukocytes > 13 · 109/l, lymphocytes > 2 · 109/l, platelets > 270 · 109/l, large (>12 fl) platelets < 27 %, triglycerides > 1.3 mmol/l, as well as combined criteria made up of these indicators. Thus, the 6-component score (heart rate, ESR, glucose, levels of leukocytes, lymphocytes, and platelets) had an area under the ROC curve of 0.87 (for values ​​> 30 units – BP 6.39 (2.16–18.9), p<0.0001) when determining the risk of an undesirable course of ACS in patients during wartime. These predictors are specific to the stress-induced effects of war and are not informative in peacetime STEMI patients.
Conclusions. The coexistence of acute stress caused by STEMI with chronic exposure to stress-associated wartime factors can worsen the course of the hospital period of STEMI, which is associated with an increase in heart rate, ESR, glucose level, leukocytes, lymphocytes, triglycerides, platelets with a decrease in their inhomogeneity in size. Taking into account these features allows predicting the risk of a complicated course of the hospital period of the STEMI in wartime.

Article Details


wartime, stress, myocardial infarction, hospital course, risk assessment, leukocytes, cellular immunity


Angkananard T, Anothaisintawee T, McEvoy M, Attia J, Thakkinstian A. Neutrophil Lymphocyte Ratio and Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis. Biomed Res Int. 2018;2018:2703518. https://doi.org/10.1155/2018/2703518.

Baginda Yusuf Siregar, Refli Hasan, Rahmad Isnanta. Association of Platelet Lymphocyte Ratio (PLR) and Neutrophil Lymphocyte Ratio (NLR) with Global Registry of Acute Coronary Events (GRACE) Score in Acute Coronary Syndrome. Int J Res Rev. 2021;8(5):1-6. https://doi.org/10.52403/ijrr.20210501.

Bains JS, Sharkey KA. Stress and immunity — the circuit makes the difference. Nat Immunol. 2022;23:1137-9. https://doi.org/10.1038/s41590-022-01276-1.

Cesari F, Marcucci R, Gori AM, Caporale R, Fanelli A, Casola G, Balzi D, Barchielli A, Valente S, Giglioli C, Gensini GF, Abbate R. Reticulated platelets predict cardiovascular death in acute coronary syndrome patients. Insights from the AMI-Florence 2 Study. Thromb Haemost. 2013;109(5):846-53. https://doi.org/10.1160/TH12-09-0709.

Chia S, Nagurney JT, Brown DF, Raffel OC, Bamberg F, Senatore F, Wackers FJ, Jang IK. Association of leukocyte and neutrophil counts with infarct size, left ventricular function and outcomes after percutaneous coronary intervention for ST-elevation myocardial infarction. Am J Cardiol. 2009; 103(3):333-7. https://doi.org/10.1016/j.amjcard.2008.09.085.

Dentali F, Nigro O, Squizzato A, Gianni M, Zuretti F, Grandi AM, Guasti L. Impact of neutrophils to lymphocytes ratio on major clinical outcomes in patients with acute coronary syndromes: A systematic review and meta-analysis of the literature. Int J Cardiol. 2018;266:31-7. https://doi.org/10.1016/j.ijcard.2018.02.116.

Hausenloy DJ, Yellon DM. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest. 2013;123(1):92-100. doi:10.1172/JCI62874

Hong D, Choi KH, Song YB, Lee JM, Park TK, Yang JH, Hahn JY, Choi JH, Choi SH, Kim SM, Choe Y, Kim EK, Chang SA, Lee SC, Oh JK, Gwon HC. Prognostic implications of post-percutaneous coronary intervention neutrophil-to-lymphocyte ratio on infarct size and clinical outcomes in patients with acute myocardial infarction. Sci Rep. 2019;9(1):9646. https://doi.org/10.1038/s41598-019-46117-8.

Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. https://doi.org/10.1093/eurheartj/ehx393.

Kossmann H, Rischpler C, Hanus F, Nekolla SG, Kunze KP, Götze K, Goedel A, Sager H, Kastrati A, Sinnecker D, Kupatt C, Ibrahim T, Schwaiger M, Laugwitz KL, Dirschinger RJ. Monocyte-platelet aggregates affect local inflammation in patients with acute myocardial infarction. Int J Cardiol. 2019; 287:7-12. https://doi.org/10.1016/j.ijcard.2019.04.009.

Mangold A, Alias S, Scherz T, Hofbauer M, Jakowitsch J, Panzenböck A, Simon D, Laimer D, Bangert C, Kammerlander A, Mascherbauer J, Winter MP, Distelmaier K, Adlbrecht C, Preissner KT, Lang IM. Coronary neutrophil extracellular trap burden and deoxyribonuclease activity in ST-elevation acute coronary syndrome are predictors of ST-segment resolution and infarct size. Circ Res. 2015;116(7):1182-92. https://doi.org/10.1161/CIRCRESAHA.116.304944.

Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978;8(4):283-98. https://doi.org/10.1016/s0001-2998(78)80014-2.

Palmblad J, Karlsson CG, Levi L, Lidberg L. The erythrocyte sedimentation rate and stress. Acta Med Scand. 1979; 205(6):517-20. https://doi.org/10.1111/j.0954-6820.1979.tb06094.x.

Schneider M, Kraemmer M, Weber B, Schwerdtfeger A. Life events are associated with elevated heart rate and reduced heart complexity to acute psychological stress. Biological Psychology. 2021;163:108-16. https://doi.org/10.1016/j.biopsycho.2021.108116.

Torpy JM, Lynm C, Glass RM. Chronic Stress and the Heart. JAMA. 2007;298(14):1722. doi:10.1001/jama.298.14.1722.

Vaduganathan M, Ambrosy AP, Greene SJ, Mentz RJ, Subacius HP, Maggioni AP, Swedberg K, Nodari S, Zannad F, Konstam MA, Butler J, Gheorghiade M; EVEREST trial investigators. Predictive value of low relative lymphocyte count in patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial. Circ Heart Fail. 2012;5(6):750-8. https://doi.org/10.1161/CIRCHEARTFAILURE.112.970525.

Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757

Wu Q, Yang Z, Qiu R, Cheng S, Zhu X, Han Z, Xiao W. The military occupational stress response scale: Development, reliability, and validity. Front Psychol. 2023;14:1032876. https://doi.org/10.3389/fpsyg.2023.1032876.

Zouridakis EG, Garcia-Moll X, Kaski JC. Usefulness of the blood lymphocyte count in predicting recurrent instability and death in patients with unstable angina pectoris. Am J Cardiol. 2000;86(4):449-51. https://doi.org/10.1016/s0002-9149(00)00963-2.

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