Американский Научный Журнал POSSIBILITIES OF PREDICTION OF RECURRENT MYOCARDIAL INFARCTION (13-16)

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patient underwent it with grade 2 hematologic toxicity
and grade 1 emetogenic toxicity.
At the momen t the patient is in a relatively
satisfactory condition, complains of periodic non -
intense dull pain in the right half of the occipital region,
neck, right side of the chest, intensifying in side
position, shortness of breath on exertion, palpitation,
gene ralized weakness. Examination detects solid fixed
conglomerate of lymph nodes of 3x3 cm large in the
right supraclavicular region, skin in the right
supraclavicular region is hyperemic, tracheostomy is
functioning.
Conclusion. Unfortunately, the most unfa vorable
prognosis is observed in patients with nonresectable
forms of thymus cancer. In patients who have not
undergone surgical treatment the 5 -year survival is
35.6%.

References
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2. Detterbeck F., Youssef S., Ruffini E., et al . A
Review of Prognostic Factors in Thymic Malignancies.
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445. doi: 10.1016/j.ijrobp.2009.02.016.
4. Machaladze Z.O., Davydov M.I., Polotsky
B.E., et al. Thymic tumors. Clinical Oncology Research
Institute, N. N. Blokhin RCRC RAMS, Moscow.
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5. Pikin О.V., Trakhtenberg А.Kh., Kolbanov
K.I., et al . Circular resection of the superior vena cava
without prosthetics in patients with mediastinal tumor
complicated by mediastinal compression syndrome.
Oncosurgery. 2013; 5: 60 –6.
6. Polotsky B.E., Machaladze Z.O., Davydov
M.I., et al . Thymic Neoplasms (Literature Review).
Siberian Journal of Oncology. 2008;1(25):75 -84.
7. Rea F., Marulli G., Girardi R., et al. Long -term
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POSSIBILITIES OF PRE DICTION OF RECURRENT MYOCARDIAL INFARCTI ON

Mullabaeva G.U 1., Kurbanov R.D 2., Jumaniyazov D.K 2
The Republican Specialized Center of Cardiology, Tashkent, Uzbekistan

Abstract . There 131 patients with Q -wave myocardial infarction were observed (mean age 51.9±9.13 year).
For all patients were prescribed beta -blockers, ACE inhibitors, statins, aspirin and if needful antiarrhythmics and
aldosterone blockators. The observational ti me was 24 months. During this period recurrent myocardial infarction
(RMI) observed in 39 (29.7%) patients. Analysis of the data showed that of the estimated factors most important for
prognosis of the RMI counts in acute early postinfarction angina pector is, arterial hypertension, diabetes Mellitus,
as well as the instrumental methods that reflect the functional state of the myocardium: LVMi, and ejection
fraction. No less important was the thrombolysis in the first hours of admission, heart rate at rest, estimated at 10 -
14 days of the disease. In addition, we can not exclude the relationship of RMI and overweight.
Key Words : recurrent myocardial infarction, prognostic model, integrated indicator.

According to the WHO in 2005 the in cidence of
acute myocardial infarction (MI) increased by 32.7%
compared with 1997 and amounted to 10.7 million
people in a population older than 50 [Cleland J.G.,
Coletta A.P et al. 2005]. The frequency of recurrent
myocardial infarction (RMI) is 25 -29%. R MI seriously
worsens the prognosis and further course of the disease,
causing a cascade of complications (heart failure (HF),
arrhythmias, a decrease in the quality of life), and also
significantly affect mortality rates [1]. Determining the
prognosis for MI is a difficult task, since it requires
taking into account a large number of interrelated
factors that have different prognostic significance [2,3].
Currently existing traditional approaches to risk
assessment are not always perfect, which makes it
diff icult to choose the appropriate treatment tactics for
this category of patients.
The purpose of the study was to carry out an
integrated assessment of risk factors for PIM, allowing
to predict its development within the next 2 years
already by 10 -14 days o f the disease.
Materials and methods: We examined 131 male
patients with primary Q wave MI, aged 30 to 69 years
(51.9 ± 9.13 years). The diagnosis was established on
the basis of the WHO criteria in the presence of two of
three signs: a characteristic atta ck of anginal pain or its
equivalent lasting at least 30 minutes, the appearance of
pathological Q or QS in two or more ECG leads, and
creatinine phosphokinase activity exceeding the upper
limit norms more than 2 times. All patients were
familiarized with the protocol and agreed to participate
in the study. The study did not include patients with the
following MI complications and concomitant
pathology: atrial fibrillation; AV blockade of the II -III
degree; arterial hypotension (blood pressure <100/60
mm Hg ); at the age over 65; with chronic diseases
complicated by renal and liver failure; decompensated
diabetes mellitus; malignant arterial hypertension;
oncological diseases; consequences of acute
cerebrovascular accident; echo -negative patients.
At the stationary stage of AMI, treatment was
carried out in accordance with the recommendations for
the management of MI patients with ST segment

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elevation and included thrombolytic therapy as
indicated, early administration of beta -blockers,
antiplatelet agents, anticoagulants, nitrates, lipid -
lowering drugs, ACE inhibitors, loop diuretics.
At the background of ongoing therapy, on 10 -14
days of AMI, all patients underwent a clinical
examination, including examination, medical history,
ECG in 12 standard leads, echocardiography, HMECG,
blood sampling for clinical and biochemical studies. To
characterize ventricular extrasystoles (VE), we used the
gradation classification B. Lown (1971) and the
prognostic classification J. Bigger (1982).
Hourly qualitative and quantitative assessments of
VEs were carried out in accordance with the Lown -
Wolf gradations: 0 -VEs are absent, 1 rare VE 2 -
frequent VE; 3 - polymorphic VE; 4A -paired VE; 4B -
group VE; 5 - early VE. According to the classification
of J. Bigger, after M I, prognostically unfavorable
ventricular arrhythmias (PUFAs) included VE> 10 per
hour, paired VE and group VE.
Anterior and posterior localization of MI occurred
at the same frequency (59.4% and 40.6% for anterior
and posterior localization, respectively) . MI without
previous angina pectoris occurred in 42% of patients;
58% had a long coronary history. 61.3% of patients
suffered from essential arterial hypertension, while
only 5.8% of them regularly received antihypertensive
therapy (beta -blockers, less of ten ACE inhibitors), the
rest were treated occasionally.
The factors likely to be significant for predicting
complications were initially considered:
• age
•arterial hypertension,
•diabetes,
• excess body weight (in this case, the presence or
absence of ea ch of them and the sum of all risk factors
were taken into account separately);
• the nature of the development of the disease
(with or without previous angina pectoris);
• localization,
• pulse
• systolic (SBP) blood pressure,
• diastolic (DBP) blood pressure,
• the nature of the heart rhythm on the 10 -14th day;
• determined by echocardiographically the final
diastolic size of the left same ventricle, stroke volume,
• left ventricular myocardial mass
• ejection fraction of the left ventricle.
The follo w-up period was 2 years. Within 2 years,
RMI was observed in 39 (29.7%) patients.
The development of the prognostic scale is based
on a modification of the Bayes probabilistic method -
the method of normalized intensive indicators (NII) [4]
with the calcul ation of prognostic, weight indices,
normalized intensive and integrated indicators. To
compile the prognostic matrix, comparable indicators
of the predicted phenomenon were obtained by
gradations of the most important factors. The
significance of factors and their gradations were
determined using the relative risk (RR) indicator, which
represents the product of the Relative Risk (RR) by the
factor’s “weight”.
Results and its discussion
Currently, mortality and disability from
complications of myocardial in farction remain high,
which necessitates increasing the effectiveness of
predicting its complications. Today, there are high -tech
methods for the prevention of post -infarction
complications - whether it is installing a cardioverter -
defibrillator to prevent sudden death or
revascularization to prevent RMI [5]. But, given the
high cost of these methods, a more objective and early
risk -stratification of myocardial infarction is required.
To assess the significance of factors affecting the
development of RMI, a risk prediction scale has been
developed. The prognostic scale of risk factors is
presented in table 1.
Table 1.
Prediction matrix for a comprehensive assessment of the risk of developing RMI .
Parameters М, % NII RR Х
(min/max) 24,5
Age Under 45 y 20,52 0,838 1,376 1,15
Older than 45 y 28,24 1,153 1,59
FC HF
No 3,24 0,132
1,349
0,18
1 3,53 0,144 0,19
2 3,99 0,163 0,22
3 4,15 0,169 0,23
4 4,37 0,178 0,24
HRV Ti
<15 s 22,22 0,907
1,184
1,07
15 -20 s 26,32 1,074 1,27
>20 s 24,56 1,003 1,19
SDNN
<50 ms 18,64 0,761
1,509
1,15
50 -100 ms 20,19 0,824 1,24
>100 ms 28,13 1,148 1,73
AH Yes 63,27 2,582 3,306 8,54
No 19,14 0,781 2,58
BMI
<25,0 kg/м² 14,31 0,584
1,991
1,16
25,0 -29,9 kg/м² 22,68 0,926 1,84
>30,0 kg/м² 28,49 1,163 2,32

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EDS >5,5 sm 28,21 1,151 1,114 1,28
<5,5 sm 25,33 1,034 1,15
ESS >3,5 sm 36,36 1,484 1,543 2,29
<3,5 sm 23,57 0,962 1,48
LVMM >200 gr 28,28 1,154 1,634 1,89
<200 gr 17,31 0,706 1,15
LVDD Е/А<1 21,88 0,893 1,750 1,56
Е/А>1 38,29 1,563 2,74
VE >10/hour Yes 27,14 1,108 1,255 1,39
No 21,62 0,883 1,11
EF <50% 25,74 1,050 1,930 2,03
>50% 13,33 0,544 1,05
VE polytopic Yes 25,00 1,020 1,188 1,21
No 21,05 0,859 1,02
VE IVA Yes 30,00 1,224 1,085 1,33
No 27,66 1,129 1,22
i LVMM >150 gr/м 2 45,15 1,843 3,076 5,67
<150 gr/м 2 14,68 0,599 1,84
Thrombolysis Yes 21,54 0,879 1,851 1,63
No 39,86 1,627 3,01
HR >80 per min 34,30 1,400 1,894 2,65
<80 per min 18,11 0,739 1,40
DM Yes 66,67 2,721 2,929 7,97
No 22,76 0,929 2,72
early post -infarction angina Yes 80,00 3,265 3,766 12,30
No 21,24 0,867 3,27
Note: M - normalizing value, RR - relative risk.

The average frequency of PIM according to the data
of the entire study was taken as the normalizing value.
So, in patients older than 45 years, the frequency of
RMI (r) was 28.24%, and up to 45 years - 20.52%. The
same indicator among all examined was 24.5%. This value
was taken as the “normalizing” indicator (M) for RMI.
Substituting the corresponding values into the above
formula, we obtained the following normalized intensive
indicators: in patients under the age of 45 years, NII1 =
20.52 / 24.5 = 0.838, and over 45 years old NII2 = 28.24 /
24.5 = 1.153 . Relative Risk Index (RR) = 1.153 / 0.838 =
1.376 (Table 1).
Similarly, NIIs were calculated for all other risk
factors, which were a standard that allowed predicting the
risk of developing RMIs, both for a single factor and for
their complex.
Knowing the relative risk index (RR) of the
occurrence of RMIs and the normalized intensive indicator
(N), we determined the strength of t he influence of each
individual factor on the development of RMIs, i.e.
prognostic coefficient (X = N * RR).
As previous studies have shown, with increasing
age, the risk of adverse outcomes with AMI increases
[6]. Our data coincide with the opinion of oth er
researchers. The relative risk indicator for age is 1.376,
NII 1 = 0.838, NII 2 = 1.153, then the integrated
indicator of the strength of influence of each individual
factor, i.e. the predictive coefficient was: 1.376x0.838
= 1.15 if the patient is unde r 45 years old and
1.376x1.153 = 1.59 if the patient is older than 45 years.
An analysis of the data obtained showed that of the
factors assessed, the most important for predicting the
development of RMI is the presence in the acute period
of early post -infarction angina, history of hypertension,
diabetes mellitus, as well as indic ators of instrumental
methods that reflect the functional state of the
myocardium: iLVMM and EF. No less important was
the conduct of thrombolysis in the first hours of
admission, the heart rate at rest, estimated at 10 -14 days
of illness. In addition, it is impossible to exclude the
relationship of the development of RMI with
overweight [7].
To determine the possible range of risk values for
the complex of factors taken, the minimum and
maximum values of the prognostic coefficient for each
factor were sum marized. Calculations showed that the
risk range is in the range of 27.91 -61.43.
The possible risk range (27.91 -61.43) was divided
into three sub -ranges: weak -buy (27.91 -39.09),
moderate - (39.09 -50.26) and high - (50.26 - 61.43) the
likelihood of a risk of developing RMI.
People with high values of the normative
integrated indicator for the totality of the complex of
studied factors have a higher probability of developing
RMIs and more prerequisites for including them in the
unfavorable prognosis group.
Th e total prognostic coefficient is in the range of
50.26 -61.43, therefore, this patient belongs to the poor
prognosis group and he needs a comprehensive medical
examination and clinical observation.
Further, according to the integrated indicator, each
facto r was assigned a certain rank. The ranking of factors
was carried out taking into account the etiological share of
the factor (Table 2.).

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Table 2
The distribution of risk factors by significance
Risk Factors RR EF, % Rank Place
early post -infarction angina 3,77 73,47 1
AH 3,31 69,79 2
i LVMM >150 gr/м 2 3,08 67,53 3
DM 2,93 65,87 4
BMI >30,0 kg/м² 1,99 49,75 5
EF <50% 1,93 48,19 6
HR >80 per min 1,89 47,09 7
Thrombolysis, no 1,85 45,95 8
LVDD Е/А>1 1,75 42,86 9
LVMM >200 gr 1,63 38,65 10
ESS >3,5 sм 1,54 35,06 11
SDNN >100 s 1,51 33,77 12
older than 45 years 1,38 27,54 13
FC HF, IV 1,35 25,93 14
VE >10/hour 1,26 20,63 15
VE polytopic 1,19 15,97 16
HRV Ti<15 s 1,18 15,25 17
EDS >5,5 sm 1,11 9,91 18
ЖЭ IVA pair 1,09 8,26 19
Data on the relative risk and etiological percentage
of factors at risk of developing PIM indicate that factors
of almost complete dependence of RMI were not
identified.
A very high conditionality of the disease is
associated, respectively, with early post -infarction
angina (RR = 3.77; EF = 73.47%) and GB (RR = 3.31;
EF = 69.79%). A high degree of causation of an adverse
outcome is observed in the presence of LVMI> 150 g /
m2 (RR = 3.08; EF = 67.53%) and diabetes (RR = 2.93;
EF = 65.87%). Medium conditionality is associated
with a BMI> 30.0 kg / m² (RR = 1.99; EF = 49.75%);
PV <50% (RR = 1.93; EF = 48.19%); Resting heart
rate> 80 beats per min (RR = 1.89; EF = 47.09%); lack
of thrombolysis (RR = 1.85; EF = 45.95%); LV DD E
/ A> 1 (RR = 1.75; EF = 42.86%); LV MM> 200 g (RR
= 1.63; EF = 38.65%); ESS> 3.5sm (RR = 1.54; EF =
35.06%) and SDNN> 100 s (RR = 1.51; EF = 33.77%).
Conclusion:
The most informative in terms of predicting the
development of RMI in patients undergoing Q -IM, is
the presence of early post -infarction angina, a history
of AH, LV hypertrophy, the presence of diabetes and
excess body weight.

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