Acute coronary syndrome without ST-segment elevation on electrocardiogram: clinical and anamnestic factors of poor prognosis at hospital period
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Abstract
The aim – to study the risk factors of an unfavorable prognosis and identify patients groups with high risk of complications after acute coronary syndrome (ACS).
Material and methods. A total of 490 patients (pts) hospitalized with ACS without ST-segment elevation (74.49 % men and 25.51 % women, average age 58.78±0.44 yrs) with acute clinical destabilization that occurred no more than 72 hours before admission to the hospital were examined. The diagnosis of acute myocardial infarction (MI) or unstable angina pectoris was established according to the ESC guidelines. The anamnestic and clinical factors affecting the course of the hospital period were identified. The end points of the study, in addition to the clinical signs, were additionally formed combined endpoint: MI/cardiovascular death/recurrent angina pectoris (MI/CVD/RAP), MI/CVD/acute heart failure (MI/CVD/AHF), MI/CVD/ AHF/RAP.
Results. Most patients had arterial hypertension (AH) (77.35 %) and ischemic heart disease (IHD) (72.04 %) in the anamnesis, including a previous MI – 43.06 %. There were 34.08 % active smokers and 53.88 % – smokers in the past; overweight was detected in 16.53 %, type II diabetes mellitus (DM) – in 16.12 %. Acute HF, MI and death were detected with similar frequency in men and women. RAP developed in women more often than in men (46.4 % vs 29.3 %, respectively, Р<0.001). Ventricular arrhythmias (VA) were registered more often in men (15.1 % vs 6.4 %, Р<0.05). There were no significant differences in the middle and older groups. AHF, RAP, and MI/CVD/RAP, MI/CVD/AHF and MI/CVD/AHF/RAP have developed or progressed more often in men with DM than in women. In men, the presence of DM in 2 times increases AHF developing risk (Р<0.05) during the hospital period, 4 times the risk of progression AHF (Р<0.01), 2 times the risk of RAP, MI/CVD/RAP, MI/CVD/AHF/RAP (Р<0.05, in all cases) and almost 5 times the risk of MI/CVD/AHF (Р<0.01). Significant differences during the hospital period are observed in pts younger than 55 yrs and older than 65 yrs. There were no differences in middle age pts. The IHD history significantly increased the AHF progression, RAP development and the frequency of combined endpoint: MI/CVD/RAP, MI/CVD/AHF, MI/CVD/AHF/RAP. The previous MI did not affect the development of the hospital period complications of ACS without ST elevation. Chronic heart failure (CHF) in the history significantly increased the risk of AHF development during the hospital period of ACS, as well as the risk of AHF developing on the 1st day of the disease, the development of RAP and combined CT: MI/CVD/RAP, MI/CVD/AHF/RAP. The presence of AH significantly increased RAP development risk by 26 %.
Conclusions. Factors of poor prognosis of the hospital period in patients with ACS without ST segment elevation include DM in men, IHD, CHF and AH in the history. The risk of RAP, MI/CVD/RAP, MI/CVD/AHF/RAP are significantly higher in women than in men, while VA reliable more frequently develop in men. The most important gender differences regarding development of hospital complications are observed in patients younger than 55 yrs.
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