Long-term trends and predictors of the clinical course and outcome in acute coronary syndrome
Aim. To analyse the long-term trends in the acute coronary syndrome (ACS) outcomes; to identify the predictors of ACS clinical course and outcomes using a discrimination model. Material and methods. From 1993 to 2011, over 31000 patients with suspected ACS, including 8686 patients with acute myocardial infarction (AMI), were hospitalised to the Acute Cardiac Care Unit of the Voronezh City Clinical Hospital of Emergency Medical Care No. 10. The present analysis includes 565 patients (311 men, 55%). Results. Over 18 years of the follow-up, no significant increasing or decreasing trend in in-hospital mortality was observed. In all hospitalised patients, the mean level of in-hospital mortality was 3,91% per year; in ACS patients, it was 13,65%. The outcome predictors included age, degree of myocardial damage, Killip class, the degree of ST segment deviation, ST segment depression, and corrected QT interval dispersion. A discrimination model was created, which identified the groups with poor, ambiguous, and good prognosis. Overall, the classification matrix was accurate in 96,4% of the patients. Conclusion. The long-term trend in the levels of in-hospital mortality among ACS patients failed to demonstrate any marked reduction. The proposed discrimination model accurately predicted the clinical course and outcomes of ACS.