Pylova T. Peculiarities of clinical course and prognosis of the patients with stable ischemic heart disease depending on ischemia development mechanism

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

State registration number


Applicant for


  • 222 - Медицина


Specialized Academic Board

ДФ 64.609.035

The Kharkiv Medical Academy of Postgraduate Education


The aim of this study was to increase the effectiveness of treatment of patients with stable angina without obstructive atherosclerotic coronary arteries - (ischemia with nonobstructive coronary arteries, INOCA) by establishing the features of the clinical course and determining the leading laboratory and instrumental prognostic criteria. The problem is very relevant because in recent years the number of patients with coronary heart disease (CHD) is growing steadily. It is known that the cause of coronary heart disease can be not only atherosclerosis of the coronary arteries. The results of the introduction of modern invasive and non-invasive diagnostic methods indicate that the proportion of patients with microcirculatory disorders is quite large. According to the data, patients with INOCA are associated with a poor long-term prognosis, have a high risk of developing myocardial infarction and an increased incidence of hospitalization associated with heart failure (HF). Information on the management strategy, prevention of complications and treatment of patients is very little and does not always coincide with the positions of clinical recommendations, which is a great field for discussion and became the subject of study in our study. The study included two types of design: I (retrospective) - for analysis were selected 1000 case histories of patients consecutively hospitalized to KNP "City Clinical Hospital № 8" Kharkiv City Council for the period from January 2015 to December 2019 from diagnosis of MI, which was established in accordance with the fourth universal definition of MI. All patients in the acute period of MI underwent coronary angiography (CAG). There were 33 patients that conform to the criteria for the diagnosis of acute myocardial infarction without obstructive atherosclerotic coronary artery disease (MINOCA), which were analyzed in detail (І group). Group II included 73 patients with myocardial infarction, who were hospitalized from June to December 2019 and according to CAG had stenoses of infarct-dependent CA more than 50%. The clinical and anamnestic data, results of laboratory tests, ECG and ultrasound examination of the heart, CAG data contained in case histories were analyzed. The purpose of the retrospective study was to analyze the clinical and anamnestic parameters and features of the clinical course of MI, which determine the leading risk factors and prognosis in patients with MINOCA. After 1 year (±2 months), echocardiography was evaluated and the factors influencing the development of post-infarction heart remodeling in the long term in patients with acute myocardial infarction were studied. 12 factors connected with the risk of the development of remodeling heart were determined using single-factor analysis based on the results of retrospective analysis of the patients with myocardial infarction, taking into account clinical-anamnestic characteristics, laboratory and instrumental studies data and based on a multivariate logistics analysis of independent predictors of the complications development in an acute period of myocardial infarction. On the basis of logistic regression analysis, a ranking of prognostic significance of factors was carried out, which allows to assess the risk of remodeling heart developing in patients who have undergone acute myocardial infarction by a complex of prognostically significant parameters of each factor. In the process of constructing a logistic regression model, adding and removing the parameters of each of the defined factors associated with the risk of remodeling heart developing, 9 factors turned out to be most prognostic: hyperlipidemia (Х1), arterial hypertension (Х2), transit ischemic attacks (Х3), atrial fibrillation (Х4), heredity of cardiovascular disease (CVD) (Х5), end-diastolic (EDI) / end-systolic (ESI) indices (Х6), ejection fraction index (Х7), age (Х8) and smoking (Х9). The worked out prognostic model allows the assessment of the risk of remodeling heart development in patients of various age with sensitivity 94% and specificity 96%.


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