Home – Home – Jornals – The journal "Ateroskleroz" 2012 number 1

Aims. To evaluate the clinical and prognostic role of hemodynamically insignificant stenosis of the extracranial arteries and lower extremity arteries in patients after myocardial infarction with ST - Segment elevation. Methods and results. The study sample consisted of 423 consecutively admitted patients in Kemerovo Cardiological Clinic with ST-Segment elevation myocardial infarction (STEMI). The disease outcome was defined in 397 patients (95.4 % of the initially discharged patients) a year later. 39 fatal outcomes were registered. The incidence of polyvascular diseases (PVD), defined by the intima-media thickness of the common carotid artery or presenting stenosis of any severity of the extracranial arteries (ECA) or lower extremity arteries (LEA) was substantially high - 95 %. The increasing severity degree of peripheral arteries stenosis was noted to raise significantly the cardiovascular risk factors incidence. In patients without PVD (n = 18) no fatal outcomes were registered, in patients with the ECA or LEA stenosis - >30 % (n = 193), the mortality rate was 5.7 %, and with stenosis < 30 % (n = 186) - 15,1 % (χ² = 11,4, p = 0.003). Using the GRACE score model together with the additional factors determination (presenting congestive heart failure, PVD, prior stroke, smoking) enables to create a scheme (KemScore) of death risk stratification for 12-month period, with the value of the area under the ROC-curve 0.83 (0.76, 0.90), that is significantly higher than the initial GRACE score - 0.71 (0.63, 0.79). Conclusion. Additional risk factors determination, including peripheral arterial stenosis of 30 % and more, enables to optimize the predictive GRACE score model value.