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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4048_Библиотеки_им_академика_М_И_Перельмана
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191
Fig. 5.16. Kaplan-Meier survival curves – the incidence of deaths/acute coronary
events in Group 1, Group 2 and control group.
The mean time to reach the cumulative death/ACS point was 151 days, 25%
quartile – 62, 75% quartile – 244.
Comparative characteristics of patients with acute coronary events are given in
Table 5.4.
Table 5.4.
No deaths/ACS
N=381
Death/ACS
N=27
P value
Age (years)
61±11
70±12
Р<0.00005
Sex (M/F)
248/133
18/9
NS
BMI (kg/m2)
28,7±4,6
27,3±5,5
NS
Hypertension
317 (83,2%)
23 (85,1%)
NS
192
Previous CAD
172 (45,1%)
10 (37,0%)
NS
Previous PCI
89 (23,3%)
2 (7,4%)
NS
Diabetes mellitus
56 (14,6%)
3 (11,1%)
NS
Previous MI
119 (31,2%)
6 (22,2%)
NS
Echocardiography
EF, %
61,6±10
57,2±17
0.04
EDV, ml
108±36
114±38
NS
Exercise test
Maximal HR
(beats/min)
110±20
108±13
NS
Exercise capacity
(W)
78±37
57±16
<0.05
Maximal blood
pressure, mmHg
173±26
167±24
NS
Coronary artery velocity at rest
Max velocity in
LM/proximal
LAD/proximal LCx
87±35
125±45
Р<0.000001
Max velocity in
middle LAD/middle
LCx
78±40
116±31
NS
LM – left main artery; pLAD – proximal portion of left anterior descending artery; pLCx –
proximal portion of left circumflex artery; mLAD – middle portion of left anterior descending
artery; mLCx – middle portion of left circumflex artery.
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193
Multivariate and ROC Analysis
The age limit value for predicting deaths and acute coronary events was over 70
years. Sensitivity was 54%, specificity – 82%, accuracy – 71%, p<0.0002. Fig.
5.17.
Fig. 5.17. The accuracy of predicting death/ACS by age
The exercise capacity limit value for stress echocardiography for predicting deaths
and acute coronary events was less than or equal to 50 W. Sensitivity was 77%,
specificity – 53%, accuracy – 67%, p<0.003. Fig. 5.18.
194
Fig. 5.18. The accuracy of predicting deaths/ACS based on the exercise capacity.
The limit value blood flow velocity in the proximal portions of the left coronary
artery for predicting deaths and acute coronary events was more than 97 cm/s.
Sensitivity was 71%, specificity – 69%, accuracy – 76%, p<0.0001. Fig. 5.19.
Рекомендовано к изучению сайтом МедУнивер - https://meduniver.com/
195
Fig. 5.19. The accuracy of predicting deaths/ACS by velocity in the proximal
portions of the left coronary artery.
The ROC analysis did not determine a significant distribution of patients according
to the ejection fraction for predicting the point of death/ACS.
In multivariate analysis, the maximum velocity in the proximal portions of the left
coronary artery (R 1.01, 95% CI 1.01–1.02, р<0.005) and ejection fraction (OR
0.97, 95% CI 0.94–0.99, P<0.05) were independent predictors of deaths/acute
coronary events.
5.4.5.4. Analysis of the incidence of adverse outcomes
This part analyzes the data of the group with a common point of unfavorable
outcomes: death, myocardial infarction, pulmonary edema, unstable cardiac angina,
myocardial revascularization. There were 207 (50.74% of patients from all groups)
patients with adverse events: 17 deaths, 8 nonfatal myocardial infarctions and/or
pulmonary edema, 2 acute coronary syndromes, and 184 patients who underwent
revascularization. In group 1, 165 (62%) patients reached the control point. In
196
group 2 – 42 (47%). There were no patients with the listed adverse events in the
control group, p<0.00001. Kaplan-Meier curves Fig. 5.20.
Fig. 5.20. Kaplan-Meier survival curves – the incidence of adverse outcomes in
Group 1, Group 2 and control group.
The median time to reach the baseline of adverse outcomes was 91 days, 25%
quartile 35, 75% quartile 120.
Comparative characteristics of patients who reached and did not reach the control
point are given in Table 5.5.
Table 5.5.
Didn't reach the
control point
N=201
Reached the
control point
N=207
P value
Age (years)
61,4±12
62,3±10
NS
Sex (M/F)
114/87
152/55
0.0004
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197
BMI (kg/m2)
28,6±5
28,6±5
NS
Hypertension
159 (79%)
175 (84%)
NS
Previous CAD
66 (33%)
116 (56%)
0.000001
Previous PCI
28 (14%)
63 (30%)
0.00004
Diabetes mellitus
20 (10%)
39 (19%)
0.01
Previous MI
38 (19%)
87 (42%)
0.000001
Echocardiography
EF, %
62,4 ±10
60,3±11
NS
EDV, ml
106±34
111±38
NS
Exercise test
Maximal HR
(beats/min)
119±23
103±33
0.0000001
Exercise capacity
(W)
94±44
65±23
0.0000001
Maximal blood
pressure, mmHg
180±26
166±23
0.00005
Coronary artery velocity at rest
Max velocity in
LM/proximal
LAD/proximal LCx
75±37
104±33
0.0000001
Max velocity in
middle LAD/middle
68±35
92±42
0.000009
198
LCx
LM – left main artery; pLAD – proximal portion of left anterior descending artery; pLCx –
proximal portion of left circumflex artery; mLAD – middle portion of left anterior descending
artery; mLCx – middle portion of left circumflex artery.
Multivariate and ROC Analysis
The limit value heart rate at the peak of physical exercise for predicting
unfavorable outcomes was less than or equal to 114 beats/min. Sensitivity was
82%, specificity – 55%, accuracy – 70%, p<0.0001. Fig. 5.21.
Fig. 5.21. The accuracy of predicting adverse outcomes in terms of the heart rate at
the peak exercise.
The exercise capacity limit value for stress echocardiography for predicting
adverse outcomes was less than or equal to 75 W. Sensitivity was 87%,
specificity – 47%, accuracy – 71%, p<0.0001. Fig. 5.22.
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199
Fig. 5.22. The accuracy of predicting adverse outcomes based on the exercise
capacity.
The limit value blood pressure at the peak exercise for predicting adverse
outcomes was less than or equal to 180 mm Hg. Sensitivity was 79%, specificity –
47%, accuracy – 65%, p<0.0001. Fig. 5.23.
200
Fig. 5.23. The accuracy of predicting adverse outcomes in terms of blood pressure
at the peak exercise.
The limit value blood flow velocity in the proximal portions of the left coronary
artery for predicting adverse outcomes was more than 78 cm/s. Sensitivity was
85%, specificity – 53%, accuracy – 72%, p<0.0001. Fig. 5.24.
Рекомендовано к изучению сайтом МедУнивер - https://meduniver.com/
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