The dissertation is devoted to the study of the course of acute coronary syndrome (ACS) without ST segment elevation on the ECG, the risk factors of complicated course, the study of short-term and long-term prognosis.
The paper deals with the study of the complex use of anamnesis data, instrumental and laboratory results of examinations to detect marrows of unfavorable course of ACS without ST segment elevation during the hospital stay and long-term observation.
The aim of the study was to identify markers of complicated ACS without ST segment elevation on the ECG in order to stratify the risk of cardiovascular complications and identify high-risk patients.
The dissertation research is based on the results of a comprehensive examination and analysis of 490 patients with ACS without ST elevation of the during the hospital period and with long-term follow-up (1, 3 and 5 years).
The dissertation provides a theoretical and scientific justification for solving an important problem for practical medicine - stratification of disease prognosis, which consists in assessing the patient's history, clinical, laboratory and instrumental examinations at the time of hospitalization, during the hospital stay and the impact on short long-term survival of patients.
The study used modern common endpoints, such as cardiovascular death, nonfatal myocardial infarction, unstable angina, stroke, acute left ventricular failure (during the hospital stay), and combined endpoints, which included the above criteria.
The dissertation used an automated algorithm for selecting comparable pairs (Case-match-Control) for accurate comparison of comparison groups and valid static analysis, which made it possible to analyze remote observation in a relatively small sample of patients with high statistical power.
As a result of the research, it was found that the use of routine clinical, laboratory and instrumental data and the use of modern statistical methods (single-factor, multifactorial regression Cox regression, endpoint studies using Kaplan-Meyer analysis, log-run test, etc.) markers of unfavorable course of ACS without ST elevation. This makes it possible to predict the further outcomes of the disease. By choosing treatment methods, "aggressive" approaches to monitoring the adequacy of drug strategies, the impact on risk factors that can be modified, it is possible to improve the quality and life expectancy of patients.
The prognostic properties of the risk scale for the development of endpoint CVD/MI/UA during the 1st, 3rd and 5th years after ACS were developed and evaluated. In order to build a forecasting scale, regression techniques were used with the inclusion of the most important risk factors.
Determining the most predictively significant level of individual quantitative indicators and assessing the informativeness of the risk scale in predicting the onset of endpoint was performed using logistic regression and the creation of ROC-curves. In the first stage of the analysis, the method of constructing one-factor models of logistic regression was used to identify the relationship of factor traits with the risk of reaching the end point. Based on this analysis, scales for assessing the risk of achieving CT were developed.
The analysis of the informativeness of the models in terms of 1, 3 and 5 years showed that the sensitivity and specificity of the model for predicting adverse events during 1 year is the most acceptable.
Validation of models for predicting the risk of endpoins CVD/MI/UA after NSTEMI was performed on new data (confirmatory data set). The use of models for assessing the risk of adverse events after discharge from the hospital confirmed their prognostic significance and can be used in real clinical practical.
