RESUMEN
AIM: Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods. MATERIAL AND METHODS: A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups. RESULTS: Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (<0.3%), medium (0.3-9%), high (9-17%), and very high (>17%) risk groups. CONCLUSION: The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.
Asunto(s)
Mortalidad Hospitalaria , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del ST , Humanos , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/efectos adversos , Masculino , Femenino , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo/métodos , Anciano , PronósticoRESUMEN
Infusion therapy, surgical debridement of an infection focus, and antimicrobial therapy are basic treatments for severe sepsis. At the same time there are no uniform guidelines on how to choose fluids for infusion therapy. The results of individual studies serve as the basis for refusing the use of synthetic colloid agents in the therapy of severe sepsis. The presented multicenter, randomized comparative study has evaluated different synthetic colloid solutions in early targeted therapy for severe sepsis. Evidence is provided for the identical effectiveness of the compared solutions in correcting hypovolemia and stabilizing hemodynamics in patients with severe sepsis and septic shock.