Download Impact factors influencing patient`s prognosis with acute coronary

Impact factors influencing patient’s prognosis with acute coronary syndrome
Bashkir State Medical University, Ufa, Russian Federation
Travnikova E.O., Zagidullin B.I., Zulkarneev R.H., Zagidullin Sh.Z., Zagdullin N.Sh.
Background. The prognosis of acute coronary syndrome (ACS) at admission to the
hospital seems to depend from different variables.
Aim. To estimate the dependence of survival rate of patients hospitalized with diagnosis
acute coronary syndrome (ACS) from different variables at admission.
Methods. Retrospective study of 800 hospital patient’s act with ACS (435 men, 315
women) was performed. 1st group were 680 survives, 2nd group - 70 patients who died
during the hospital stay. The following factors and their impact on prognosis were
analyzed: age, gender, duration of coronary heart disease (CHD), myocardial infartion
(MI) in anamnesis, treatment in Intensive Care (ICE) unit, complications, atrial
fibrillation, ventricular tachycardia, atrial extrasystole, heart rate (HR) at admission. The
binary logistic model prognostic model was constructed. Model specification was
performed on the base of Akaike and Schwarz coefficients. From 57 variables the 6 most
important ones were selected.
Results. Mean age was 64.4±1.4 in the 1st group and 64.7±2 – in the 2nd. Myocardial
infarction was in anamnesis in 295 patients in the 1st and 22 in the 2nd. Mean HF at
admission was 82.0 per minute in thе 1st group and 92.3 – in the 2nd. HF at admission
directly correlated in with mortality (r=0.26).
On the base of logistic analysis the following coefficients were mostly valuable for the
prognosis: age (coefficient= – 0.22±0.53%, probability=0.67), atrial extrasystole (–
0.25±1.3, 0.84), HR at hospital admission (0.004±0.02, 0.81). The acquired logistic model
of binary type was: y=0.699x1 + 1.912x2 - 3.22x3 + 4.289x4 + 0.78x5 - 0.03x6, where y independent lethality probability, x1 - age, x2 - MI in anamnesis, x3 - ICE care, x4 - atrial
fibrillation, x5 - ventricular tachycardia and x6 - metoprolol tartrate dose. Testing of
model adequacy was performed with Macfaden coefficient and was close to 0.5
(RMF2=0.4476) that means adequate quality of the model. The results shows that age
increase the lethality ratio on 0.93%, atrial fibrillation decrease on -0.42%, internal care
unit treatment – on 4.2%.
Conclusions. Patient parameters at admission allow to create predictive model and to
estimate the factors, impacting the prognosis of patients with ACS. Age, atrial fibrillation
and intensive care treatment seemed to be mostly valuable for patient’s prognosis.
Research project was done with support of State Federal Agency on Education "Scientific
and pedagogical resources of modern Russia" and scientific project of Russian State
Scientific Foundation «Heart rate as a rusk factor of cardiovascular disease and study of
arrythmogenesis » №12-36-01303.
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