COMPUTERIZED FORECASTING MYOCARDIAL INFARCTION AND INSULT

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Vorobyova E.N. Usolkin K.M. Much E.A. Vorobiov R.I. Nasonov V.A. Gavrilenko N.M. Статья в формате PDF 119 KB The urgency of a problem of cardiovascular system illnesses prophylaxis is defined by high parameters of a case rate and mortality of the population from this pathology. According to modern representations tactics of the medical references is based on size of cooperative coronary risk. By the purpose of research was the approbation of computerized forecasting of a myocardial infarction and insult after a complex assessment of risk factors.

Under observation was 560 practically of able-bodied persons, at which alongside with anamnestic, biographical, anthropometric, clinical (gauging of arterial pressure), function researches (ECG) was carried out definition of concentration of a common cholesterin (TC) and cholesterin low lipoprotein (LDL) and high (HDL) density, triglycerides.

The various risk factors - smoking, arterial hypertension etc. were revealed. At 156 surveyed (28 %) are revealed those or other infringements of a lipid metabolism. An assessment results of laboratory researches in aggregate with other risk factors of illnesses cardiovascular system took into account in the developed computer programs of a complex risk factors assessment prognosticating probability of a myocardial infarction "Computerized system of an assessment(evaluation) of risk factors of cardiovascular diseases - (Risk)" and an insult "Assessment of risk factors of an insult - (Insult)". By one of modules of the programs was the algorithm of account of risk on the establishment of the formulas Framingham research (Framingham) and PROCAM (Multiple Risk Factors Intervention Trial, Munster Heart Study), in which utilised 9 variable: age, smoking, anamnesis of a stenocardia, family anamnesis a myocardial infarction, systolic pressure - sBP, LDL, HDL, triglycerides, diabetes, left ventricular hypertrophy (LVH) till according ECG.

The algorithm of risk of an insult pays off under the formula Framingham p=1-exp (-eu), where u=[log(t)-µ]/s, µ=4.4181+m, s=exp [-0.3155-(0.2784ґm)]. Men m=a-[1.4792ґlog(age)]-[0.1758ґ(diabetes=1, no=0)], Women m=a-5.8549+[1.8515ґ [log(age/74)]²]-[0.3758ґ(diabetes=1, no=0)], где a=11.1122-[0.9119ґlog(sBP)]-[0.2767ґ(smoker=1, no=0)]-[0.7181ґlog(TC/HDL)]-[0.5865ґ(ECG-LVH=1, no=0)]

The risk of a myocardial infarction is prognosticated under the formula PROCAM: I=1 / [1+exp (-y)], where y =-12.3199 + (ageґ0.1001) + (sBP). An itemґ0.0118) + (LDLґ0.0152) + (HDLґ-0.045) + (loge (triglycerides) ґ0.3346)+( smokeґ0.9266)+( diabetesґ0.4015) + (family anamnesis of an myocardial infarct ґ0.4193) + (CHDґ1.319).

The definition of risk of an insult on algorithm Framingham at the practically able-bodied persons has shown, that it has made on the average 0,65+0,13 %, at the men - 0,72+0,13 %, at the women - 0,63+0,14 %. Besides all surveyed were referred to any other business part of global risk PROCAM of probability of a myocardial infarction. Parts had the following target points: 1-st > 0.91 % for 8 years (> 0.11 % per one year), 2 0.92-1.40 % for 8 years (0.12-0.18 % per one year), 3-rd 1.41-3.65 % for 8 years (0.18-0.46 % per one year), 4-th 3.66-7.60 % for 8 years (0.46-0.95 % per one year), 5-th > 7.60 % for 8 years (> 0.95 % per one year). Thus according to algorithm PROCAM surveyed 1-st and 5-th part differed on a degree of risk in 40 times. At 117 persons the index of coronary risk was entered in borders 1-2 parts of risk for the proximate 10 years (" small risk "), at 320 surveyed the index got in 3-rd, 45 - in 4-th part, regarded as " moderate risk " of vascular infringements, and at 78 men conformed ("to high risk ") - 5-th part.

According to the certain risk level the references on "paravariation" of a mode of life (correction of a diet, hypodynamia, abandoning of harmful habits), hypotensive drugs were given, and 89 patients with "high" risk of an insult and having 4 and 5 parts of risk of a myocardial infarction with the expressed infringements of a lipid exchange, were recommended follow-up hyrolipidemic drugs.

The results of our researches demonstrate the important value of definition of individual risk of a myocardial infarction and insult on preclinical stage of a cardiovascular pathology. The establishment of a risk level of the concrete patient achieved with the help of clinical, laboratory and other data, and also quantitative assessment of risk on algorithms Framingham or PROCAM allows to individualize and is well-timed to recommend not and medicamental correction of risk factors.

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