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Independent Predictors for the Severity of Coronary Artery Disease in Patients with Myocardial Infarction without St-Segment Elevation

Summary It is well known that the severity of coronary heart disease is associated with a poor prognosis. 70% of patients with NSTEMI have multivascular disease, the percentage being 40% for STEMI patients. Knowing the grade severity of the coronary artery disease has importance for the therapeutic management of the case and to establish the prognosis. However, until now, we have no possibilities to identify these patients before performing the coronarography. The objective of this study was to establish a correlation between cardiovascular risk factors, ECG changes, echocardiographic changes, GRACE score and the severity of coronary artery disease invasively detected by coronarography, in patients with myocardial infarction without ST-segment elevation. Material and methods. We performed a study on 125 patients diagnosed with NSTEMI, who performed coronarography. For each patient we noted age, sex, history of high blood pressure, dyslipidemia, chronic kidney disease, smoking habit, HS troponin T levels, LDL cholesterol, triglycerides, C-reactive protein, creatinine clearance, ejection fraction of left ventricle, number of lesions discovered on angiography, GRACE and SYNTAX score. Results. Of the 125 patients included, 86 (68.8%) were men, with a mean age of 63.66 ± 11.54. The average of the laboratory tests and the parameters studied: creatinine Cl 83.80 ± 33.862 ml / min, FEVS 46.37 ± 7.394%, troponin HS 3533.625 ± 7460.873 pg / ml, CRP 2.811 ± 5.262 mg / dl, LDL 113.618 ± 50.13 mg / dl, triglyceride ± 100.58mg / dl. The mean Syntax score in the studied group was 17, 58 ± 13.65, Grace score 118.80 ± 26.980, and the number of coronary lesions 2.19 ± 1.162 The number of coronary lesions and the SYNTAX score were significantly correlated statistics with age, Grace score, presence of diabetes and chronic kidney disease. With regard to laboratory tests, creatinine clearance proved to be the most important predictor for both the number of vessels affected (r =-0.322, p=0.000) and for the Syntax score (r = -0.323,p=0.000), the latter being influenced also by the level of triglycerides (r = -0.177, p = 0.048) and that of the high sensitive troponin (r = 0.322, p = 0.015). Conclusions. Independent predictors of multivascular disease in patients with NSTEMI are : age, diabetes, chronic kidney disease, creatinine clearance and Grace score. The severity of the coronary heart disease assessed by the Syntax score, is also correlated with age, history of diabetes and chronic kidney disease, creatinine clearance, Grace score, but also with the value of tiglycerides and high-sensitive T troponin.