The correlation of the severity of the clinical condition in patientswith acute myocardial infarction without ST-segment elevation and the degree of coronary artery lesion by SYntaX score

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Abstract

Aim. To find the relationship of the clinical status of patients with acute myocardial infarction without ST-segment elevation (NSTEMI) from the baseline condition of the coronary arteries (CA) according on SYNTAX Score (baseline SYNTAX score - BSS). Materials and methods. Were examined 421 patients. All performed coronary angiography and endovascular procedures (EVP) up to 14 days from the beginning of acute myocardial infarction. Assigned 3 groups: 1st - BSS<12 (54.3%), 2nd - BSS 13-22 (23.1%) and 3rd - BSS>22 (22.6%). The clinical condition was assessed by: Killip classification, GRACE scale, left ventricular ejection fraction (LVEF), creatine kinase and creatine kinase-MB data and mortality. Results. Thus, in the group of patients with BSS<12 points pulmonary edema (Killip 3/4) occurred only in one case (0.4%), whereas among patients with BSS>12 points it was detected in 8 4.2%) patients (p<0.05). Pulmonary edema or cardiogenic shock were observed in cases when the infarct related artery (IRA) were: left main spread to the anterior interventricular artery (AIVA), ostium and/or proximal segment of the AIVA. In group 3, high-risk patients according to the GRACE score were observed significantly often (49.5%) vs 2nd (27.8%) and 1st (21.8%) groups respectively (p<0.05). In the third group of cardiospecific enzymes were significantly higher (p<0.05). LVEF<45% was detected in 5.7% of patients of group 1, and in 14.4% and 18.9% in the 2nd and 3rd (p<0.05). Conclusion. Determining factors of the clinical status of patients with NSTEMI are: the degree of lesion of CA according to BSS and hemodynamic significance of the IRA itself. The "line" of differentiation of possible complications in the period before EVP should be considered BSS>12 points.

About the authors

Ionatan R. Rafaeli

Sechenov First Moscow State Medical University

Email: rafaeli50@yandex.ru
д-р мед. наук, сердечно-сосудистый хирург

Alexandra Lu. Kireeva

Sechenov First Moscow State Medical University

врач функциональной диагностики

Nataliia V. Kuchkina

Sechenov First Moscow State Medical University

зав. клинико-биохимической лабораторией

Anna N. Rogatova

Sechenov First Moscow State Medical University

зав. отд-нием функциональной диагностики

Nino V. Tsereteli

Sechenov First Moscow State Medical University

канд. мед. наук, зав. отд-нием инновационных методов диагностики и лечения больных с хроническими формами заболеваний сердечно-сосудистой системы

Irina E. Chernysheva

Sechenov First Moscow State Medical University

канд. мед. наук, Научно-практический центр интервенционной кардиоангиологии

Sergei P. Semitko

Sechenov First Moscow State Medical University

д-р мед. наук, проф. каф. интервенционной кардиоангиологии

David G. Ioseliani

Sechenov First Moscow State Medical University

акад. РАН, д-р мед. наук, проф., зав. каф. интервенционной кардиоангиологии

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