PREDICTION MODEL OF HOSPITAL MORTALITY AMONG PATIENTS WITH ACUTE MYOCARDIAL INFARCTION AND CONCOMITANT TYPE 2 DIABETES MELLITUS

Zaikina T. S.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The new markers sCD40-ligand and sVE-cadherin reflect the presence and degree of endothelial dysfunction manifestation. In spite of the high interest to the search of new criteria for predicting the AMI course, the role of sCD40L, sVE-cadherin has not been studied enough. The aim of study was to elaborate the prediction model of hospital mortality in the patients with acute myocardial infarction and type 2 diabetes mellitus. Materials and methods: The study included 60 patients with AMI and type 2 DM (among them 33 (55%) women and 27 (45%) men). The patients were divided into two groups depending on the outcome of acute period of myocardial infarction: group 1 ‒ 7 patients died during the acute period of myocardial infarction; group 2 ‒ 53 patients, survives during acute period of myocardial infarction. sVE-cadherin blood serum level and sCD40L level were determined with commercial enzyme linked immunosorbent assay ELISA kit, and all these were performed with Automated EIA Analyzer «LabLine-90» (Austria). Levels of total cholesterol, LDL, VLDL, HDL and TG were measured biochemically. QUICKI index was measured mathematically. The data were processed statistically with Microsoft Office Excel software: the mean arithmetial value (М) and standard error of the mean (m) were calculated, for estimated probability and validity of the obtained data, Student’s t-test (р) was done. For risk stratification modeling, stepwise logistic regression SPSS method was used. Results and discussion. To evaluate the risk of hospital mortality within acute period of myocardial infarction in the patients with type 2 DM a prediction model was built by stepwise logistic regression SPSS method. This model allows to divide all patients into the groups of high and low risk of fatal outcome by means of L calculation (logit, i. e., combination of values of predictive indices with coefficients which have the most predictive effect. L= -286.5+16.9*A+887.1*B+1.25*C, i.e. Y= 1/(1+EXP(286.5+16.9*A+887.1*B+1.25*C)), where Y ‒ the group of hospital death risk in AMI patients with DM2; А ‒ LDL level, mmol/L; B ‒ QUICKI; C ‒ correlation between sCD40L-ligand level at day 1 of AMI and sCD40L-ligand level, determined at day 10 of AMI, %. Diagnostic efficiency of the above mentioned model (percentage of right predictions) was 96.7%. Conclusions. With the aim to predict cardiovascular death within the acute period of myocardial infarction, the model of risk group stratification of the patients with concurrent type 2 diabetes mellitus was developed that will allow to increase survival and widen the possibilities of the treatment tactics for the patient management in this category.

acute myocardial infarction, diabetes mellitus, hospital mortality, short-term prognosis, endothelial dysfunction

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