RU2779889C1 - Method for predicting the development of myocardial rupture during myocardial infarction in men under 60 years - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology, and can be used to predict the development of cardiac muscle ruptures in myocardial infarction in men under 60 years of age. According to the ECG, signs of right ventricular hypertrophy, the presence of asystole and complete atrioventricular blockade are evaluated. The presence of thromboembolism in the patient, the presence of coronary artery bypass surgery in history, the class of acute heart failure according to T. Kilip and the presence of pulmonary edema are also assessed. Then the risk of this event is calculated for 56 days according to a given formula.

EFFECT: method allows to increase the efficiency of predicting the development of myocardial ruptures by assessing the totality of the most significant indicators.

1 cl, 2 ex

Description

The invention relates to medicine, in particular to the field of cardiology and prediction of early complications of myocardial infarction (MI) - the development of myocardial ruptures.

Myocardial rupture is a serious complication of MI, the lethality of which reaches 95% (On the issue of long-term results of surgical treatment of patients with coronary heart disease with postinfarction rupture of the interventricular septum / L.A. Bokeria, M.M. Alshibaya, S.A. Vishchipanov, O. A. Kovalenko, A. S. Vishchipanov, M. M. Amirbekov, I. P. Kvasnikova // Bulletin of the A. N. Bakulev National Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences. Cardiovascular diseases. - 2017. - V. 18, No. 1. - S. 13-18). Surgical intervention remains the main method of its treatment (Ruptures of the interventricular septum in the acute period of myocardial infarction: a review of the literature and own clinical observations / I.M. Kuzmina, A.M. Shklyarov, S.R. Gilyarevskiy, Gvindzhiliya T.R., Parkhomenko M. .V., Chursin A.V. // Emergency medical care. Journal named after N.V. Sklifosovsky. - 2017. - V.6, No. 4. - P. 47-352. DOI 10.23934/2223-9022-2017 -6-4-347-352 Experience of more than 70 cases of surgical treatment of postinfarction rupture of the interventricular septum / M. M. Alshibaya, O. A. Kovalenko, D. E. Musin, K. V. Krymov, Z. M. Cheishvili, M.F. Abadzhan // Bulletin of A.N. Bakulev National Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences Cardiovascular diseases - 2017. - V.18, No. S3. - P. 119.). With timely assistance, the patient's chances of survival increase (Experience in endovascular treatment of patients with postinfarction ventricular septal defect / I.R. Uzhakhov, E.A. Shloydo, V.K. Sukhov, K.A. Biryukov, K.S. Gigiadze / / Diagnostic and interventional radiology. - 2018. - V. 12, No. S2.1. - P. 88-89; Closure of postinfarction rupture of the interventricular septum (14-year long-term result) / R. S. Akchurin, S. L. Dzemeshkevich , D. M. Galyautdinov, A. A. Shiryaev, S. A. Partigulov, L. N. Ilyina, E. E. Vlasova, V. P. Vasiliev, V. V. Gramovich, I. S. Fedotenkov // Clinical and Experimental Surgery, Academician B.V. Petrovsky Journal, 2019, V.7, No. 1(23), P. 84-90, DOI 10.24411/2308-1198-2019-11012). The results of studying risk factors for myocardial ruptures obtained by different researchers differ significantly, and timely diagnosis is difficult because the frequency of observation of this complication is low (Kovalchuk E.Yu., Povzun A.S., pathomorphological characteristics of complicated myocardial rupture // Bulletin of the North-Western State I. I. Mechnikov Medical University - 2020. - No. 12. - P. 63-70). Thus, myocardial rupture is one of the unsolved problems of cardiology, the study of which is necessary for timely diagnosis and provision of qualified assistance. The relevance of the latter increases due to the increase in the frequency of observations of MI in men younger than 60 years (Garganeeva A.A., Tukish O.V., Kuzheleva E.A., Okrugin S.A., Kuzmichkina M.A. Portrait of a patient with myocardial infarction over a 30-year period Clinical Medicine 2018;96(7):641-647 http://dx.doi.org/10.18821/0023-2149-2018-96-7-641-647).

Currently, many risk factors for the development of myocardial rupture have been identified. They are conditionally divided into modifiable (bad habits, socio-economic) and non-modifiable (age, gender). Myocardial rupture was more often observed in elderly women who did not undergo percutaneous coronary intervention (PCI) (Management of patients with myocardial infarction in real clinical practice in the Republic of Karelia: data from a 10-year registry / I.S. Skopets, N.N. Vezikova, T D. Karapetyan, A.V. Malafeev, A.M. Malygin // CardioSomatics. - 2020. - V.11, No. 4. - P. 15-19. DOI 10.26442/22217185.2020.4.200527). In cases of death, the following were noted: higher levels of leukocytes, late hospitalization (more than 12 hours from the onset of the disease), early onset of myocardial rupture, a high proportion of rupture of the free wall of the left ventricle. Surgical intervention is considered to be the most valuable method of treatment, increasing the chances of survival (Nao Z, Ma J, Dai J, Shao Q, Shen L, He B, Jiang L. A real-world analysis of cardiac rupture on incidence, risk factors and in-hospital outcomes in 4190 ST-elevation myocardial infarction patients from 2004 to 2015 // Coron Artery Dis. 2020;31(5): 424-429. doi: 10.1097/MCA.0000000000000877. PMID: 32168044). Hypertension, chronic obstructive pulmonary disease, diabetes mellitus, and chronic kidney disease can also be predictors of myocardial rupture (Liu ZJ, Miao NT, Nie SP. [Risk factors of cardiac rupture in patients with acute myocardial infarction]. Zhonghua Xin Xue Guan Bing Za Zhi 2016;44(10):862-867 Chinese, doi: 10.3760/cma.j.issn.0253-3758.2016.10.007 PMID: 27903372). Myocardial rupture is more common in patients with ST elevation MI. Also important is increased systolic blood pressure, low hemoglobin levels, increased levels of magnesium in the blood. Also, myocardial rupture is more common in elderly patients during their first MI, it is localized mainly in the anterior wall and occurs within the first four days of MI. (Harari R, Bansal R, Yatskar L, Rubinstein D, Silbiger JJ. Papillary muscle rupture following acute myocardial infarction: Anatomic, echocardiographic, and surgical insights. Echocardiography. 2017;34(11): 1702-1707. DOI: 10.1111/echo .13739. PMID: 29082549). The works listed above studied patients without restrictions on sex and age. Dyslipidemia, low level of physical activity, bad habits (smoking, alcohol), metabolic syndrome, the presence of chronic foci of infections, frequent colds were revealed in men under 60 years of age with myocardial ruptures (Gordienko, A.V. Features of the morphofunctional state of the heart in men with repeated myocardial infarction of young and middle age / A. V. Gordienko, V. V. Yakovlev, A. V. Sotnikov // Bulletin of the Pirogov National Medical and Surgical Center - 2011. - V.6, No. 1 . - S. 99-103).

In this regard, the assessment of risk factors for the development of myocardial ruptures in a problematic social group (in men of working age) against the backdrop of almost 95% mortality seems to be relevant.

Currently, various options for predicting myocardial ruptures have been proposed. So, according to Klyuzhev V.M. et al. (patent RU 2197173 C2 A61B 5/02, publ. 27.01.2003), the method formulated by them for predicting the complications of MI is not very specific in determining, namely, myocardial rupture. Also, this method is able to determine complications only after 3-4 days of MI. In addition, it is not differentiated by age and gender. A method for predicting a rupture of the heart wall from Pavlovsky V.F. et al. (RF patent No. 2335237 C1, А61В 5/02, publ. 10.10.2008), relies on clinical, electrocardiographic (ECG) factors, laboratory markers (troponin, CPK-MB), detection of viruses (Coxsackie and/or ECHO, as well as herpes) and takes into account only patients over the age of 50 years. Malysheva A.A. et al. (patent SU 1175467 A1 G01N 33/86, publ. 30.08.1985) described a method for predicting myocardial rupture using the study of blood viscosity. If the values are 62.0-82.0 MPa, then myocardial rupture is predicted. This method requires special equipment and is not applicable to patients with arterial hypertension and physical stress. A method for predicting the course of MI according to V.N. Dymochkin. et al. (RU 2121691 C1 10.11.1998) is not specific for myocardial rupture, men younger than 60 years old, uses only the prothrombin index as a prognostic criterion on the third and fourth days of MI. The method of forecasting in MI Fialkovsky V.I. (patent No. SU 876112A1, A61B 10/00, publ. 10/30/1981) includes the study of peripheral blood for the phagocytic activity of leukocytes. It provides little information regarding the early onset of fatal complications, is not specific to myocardial rupture, and is not applicable to patients under 60 years of age. A method for predicting the complicated course of MI according to Komissarenko S.V. (Patent No. 1379739, G01N 33/49, publ. 07/03/1988) requires additional immunological studies, the determination of antibodies to cytochrome C, is not focused on myocardial rupture in men under 60 years of age. Methods Chernyaeva M.S. et al. (RU 2593791 C1 08/10/2016 and RU 2593792 C1 08/10/2016) are designed to predict the complications of acute coronary syndromes (ACS), taking into account the presence of anxiety-depressive disorders in the patient and without them, are not focused specifically on myocardial rupture, require an additional definition to perform biochemical parameters of blood not used in routine clinical practice (NADPH-GDH, NADH-GDH, GR, NADH-LDH, NADH-MDH, NADIDH and their ratios). The method of Shalenkova M.A. et al. (RU 2567031 C1 27.10.2015) is designed to predict complications of ST-segment elevation ACS. It is limited to the specified type of ACS, requires the determination of an additional marker (NGAL) in the blood on days 1-3 of the disease (not included in the standards of care), left ventricular ejection fraction, not specific for myocardial rupture, men younger than 60 years. Another way to predict the development of complications in acute coronary syndrome Shalenkova M.A. et al. (RU 2530633 C1 10.10.2014) is not specific for myocardial rupture, men younger than 60 years old, requires determination of the concentration of interleukin 6 in blood and saliva for calculation, which is not included in the examination standards for such patients. A method for predicting the risk of in-hospital mortality in patients with non-ST elevation ACS according to Bogomolov A.N. et al. (RU 2589251 C1 07/10/2016) is limited to the specified type of ACS, the age of patients older than 62 years, is not specific for myocardial rupture. A method for predicting acute MI according to Chalyk N.E. (RU 2105981 27.02.1998) does not take into account the age and sex of the patient, the possibility of myocardial rupture, requires to determine the blood sampling on the first, seventh, 14 and 21 days of the disease to isolate in a complex way and determine the properties of granulocytes, only after which its implementation is possible. A method for predicting the lethal outcome of large-focal MI according to Dabizheva A.N. et al. (RU 2246114 02/10/2005) is limited to the specified type of MI, is not specific for myocardial ruptures, does not take into account gender and age, requires the determination of CD 95 and CD 16 of neutrophilic granulocytes, which is not used in routine clinical practice. The method of preventive anesthesia in patients with complicated myocardial infarction according to Bartashevich B.I., Marinichev V.N. (2526801 08/27/2014) takes into account anginal pain syndrome, accompanied by objective criteria for increasing the tone of the sympathetic nervous system, is directed, including to patients with myocardial rupture, without taking into account the age of patients based on clinical and ECG criteria, laboratory and instrumental methods, as well as unspecified precursors of the threat of myocardial rupture. The listed symptoms are not detailed, not specific, do not have a quantitative assessment, and the method itself is aimed at improving the treatment of such patients by improving the use of analgesics. Method for the treatment of myocardial defect in acute myocardial infarction according to Kuznetsov V.A. et al. (2208399 07/20/2003) is aimed at eliminating the specified defect, does not describe the signs of its prediction and diagnosis, does not take into account myocardial rupture of other localizations.

Thus, the existing methods for predicting myocardial rupture are not always specific in relation to it (they generally take into account the risk of an unfavorable outcome or complicated course of MI), are limited by long time frames or the type of ACS / MI, are not specific to young and middle-aged men and require identification of additional (not included in the survey standards) resources (mastering complex methods for determining additional indicators).

The purpose of the invention is to increase the efficiency of predicting the development of myocardial ruptures in myocardial infarction (MI) in men younger than 60 years to improve the prevention of this condition and outcomes. The invention is based on the task of creating such a method for predicting the development of myocardial rupture in MI in men under 60 years old, which, using ordinary clinical data, taking into account the characteristics of the current group of patients, makes it possible to calculate and evaluate it and does not require additional studies, interventions, qualifications , costs, and resources in execution.

The solution of the problem is provided by the fact that in the method for predicting the development of myocardial rupture in MI in men younger than 60 years, for an individual express risk assessment of this event, the following formula is used:

p \u003d 1 / (1 + e ^-z ),

where e (mathematical constant)=2.72; a Z - auxiliary function: Z=-19.2+0.1566×A+0.949×B+l.88×C+0.82×D+2.04×E+5.88×F+0.3852 ×G, where:

A - ECG signs of right ventricular hypertrophy, 1 - no; 2 - available;

B - the presence of thromboembolism, 1 - no; 2 - available;

C - history of coronary artery bypass surgery, 1 - no; 2 - available;

D - class of acute heart failure according to T. Killip (1 - no; 2 - first; 3 - second; 4 - third);

E - the presence of asystole, 1 - no; 2 - available;

F - presence of complete atrioventricular block, 1 - no; 2 - available;

G - presence of pulmonary edema, 1 - no; 2 - available.

The value of p>0.5 indicates a high risk of myocardial rupture in MI in men younger than 60 years, p<0.5 indicates a low risk.

The claimed invention solves the problem of improving the early prediction of the risk of myocardial rupture in MI in men under 60 years of age. This problem is solved by the fact that the proposed mathematical model obtained in the target group makes it possible to quickly quantify the likelihood of this complication, starting from the first hours of the disease, based on the characteristics of the clinical course of MI and the results of electrocardiography (ECG) without attracting additional resources. This allows, from the first hours of MI, to identify a high-risk group for the development of myocardial rupture in MI among men younger than 60 years. Patients of this group are shown urgent verification of the rupture by the instrumental method, intensive therapy. This will speed up the adoption of an informed decision on the need, method and timing of operational correction.

The technical result achieved as a result of using the invention is: 1) in the earliest possible (in the first hours of the disease) obtaining a reliable individual rapid assessment of the risk of myocardial rupture in myocardial infarction in men younger than 60 years; 2) the possibility of quickly identifying a risk group for this event and carrying out a full range of therapeutic and diagnostic measures with it (first of all, verification of the gap, assessing the need for prompt repair of the gap, its method and timing of implementation; reasonable correction of the anticoagulant / antiplatelet therapy regimen; 3) activation and accelerating the decision-making process on treatment tactics and its control; 4) to increase the degree of validity of such a decision; 5) in reducing the mental burden on the participants (treatment staff, the patient and his relatives) of the treatment process and 6) improving the continuity between the various stages of patient treatment.

METHOD FOR PREDICTING THE DEVELOPMENT OF MYOCARDIAL RUPTURE DURING MYOCARDIAL INFARCTION IN MEN UNDER 60 YEARS includes calculation of the risk of myocardial rupture in case of MI in men under 60 years old according to the following formula:

p \u003d 1 / (1 + e ^-z ), where

e (mathematical constant)=2.72;

a Z - helper function:

Z=-19.2+0.1566×A+0.949×B+1.88×C+0.82×D+2.04×E+5.88×F+0.3852×G, where:

A - ECG signs of right ventricular hypertrophy, 1 - no; 2 - available;

B - the presence of thromboembolism, 1 - no; 2 - available;

C - history of coronary artery bypass surgery, 1 - no; 2 - available;

D - class of acute heart failure according to T. Killip (1 - no; 2 - first; 3 - second; 4 - third);

E - the presence of asystole, 1 - no; 2 - available;

F - presence of complete atrioventricular block, 1 - no; 2 - available;

G - presence of pulmonary edema, 1 - no; 2 - available.

A value of p>0.5 indicates a high risk of myocardial rupture in MI, p<0.5 indicates a low risk.

In the presented equation, the determination of the values of the variables is performed as follows:

I. Evaluation of the history of the disease (presence of coronary artery bypass operations): 1 - no; 2 - available.

P. Evaluation of the clinical picture of the disease:

- the presence of pulmonary edema (1 - no; 2 - available); determined clinically and/or radiographically; this information is available in the first hours of the disease (1 - no; 2 - available);

- the presence of thromboembolism (1 - no; 2 - available); the presence of thromboembolism of any localization in the structure of myocardial infarction complications is determined by

clinical and angiographic (if necessary) data; this

information is available in the first hours of the disease;

- class of acute heart failure according to T. Killip (1 - no; 2 - first; 3 - second; 4 - third) is assessed clinically in the first hours

THEM.

III. Electrocardiogram evaluation:

- the presence of signs of hypertrophy (enlargement) of the right ventricle) (1 - no; 2 - available); evaluated according to the results of an electrocardiogram taken in 12 standard leads (Orlov V.N. Guide to electrocardiography. - M., 2017. - 561 p.);

- the presence of asystole, (1 - no; 2 - available); evaluated according to the results of an electrocardiogram taken in 12 standard leads or in one lead according to the monitoring of the electrocardiogram;

- complete atrioventricular blockade) (1 - no; 2 - available); is estimated according to the results of an electrocardiogram taken in 12 standard leads or in one lead according to the monitoring of the electrocardiogram.

The value of p>0.5 in the model indicates a high risk of developing myocardial rupture, p<0.5 - a low risk.

The model can be used from the first hours of MI. For calculations, data on the history of the disease (presence of coronary artery bypass surgery in the anamnesis) is required; features of the clinical course of the disease (presence of coronary artery bypass surgery in history, thromboembolism, pulmonary edema, class of acute heart failure according to T. Killip) and ECG results (ECG signs of right ventricular hypertrophy, the presence of asystole and complete atrioventricular blockade). Thus, the information necessary to calculate the risk of myocardial rupture in MI, starting from the first hours of the disease, is included in the standard examination of a patient with MI without additional laboratory and instrumental research methods. The threat of myocardial rupture in myocardial infarction in men younger than 60 years, expressed as a percentage, can be indicated after the preliminary / final diagnosis in the epicrises of the medical history. All information for its determination can be easily obtained and calculated by a medical worker of the inpatient or outpatient stages of treatment with a level of medical education that allows to provide care to patients with MI.

The claimed METHOD FOR PREDICTING THE DEVELOPMENT OF MYOCARDIAL RUPTURE DURING MYOCARDIAL INFARCTION IN MEN UNDER 60 YEARS is carried out from the moment of the first contact with the patient and is refined after receiving the ECG results (the presence of signs of right ventricular hypertrophy, asystole and complete atrioventricular blockade). For the convenience of calculations, an electronic calculator of the model can be used, which allows you to enter the data obtained from the examination of the patient into the formula, and immediately get the result of assessing the risk of developing myocardial rupture.

The main thing when making calculations is an accurate assessment by a medical worker of the medical history, physical data of the patient, the clinical course of MI and ECG results, which is included in the list of skills for graduates of medical schools and does not require additional training.

The method is carried out in stages as the research results are obtained. If you have all the necessary data, all steps can be performed at once.

At the first stage, when evaluating the patient's complaints, collecting an anamnesis of the disease and assessing the physical data and primary results of laboratory and instrumental methods of research, the presence of coronary artery bypass surgery in the anamnesis, thromboembolism and pulmonary edema in the structure of MI complications are ascertained.

At the second stage, when evaluating the results of the ECG, the presence of signs of right ventricular hypertrophy, asystole and complete atrioventricular blockade is ascertained.

At the final stage, data is entered into the model and the risk of myocardial rupture is calculated. The resulting risk of this event as a percentage with a risk assessment is indicated in the preliminary and / or final diagnosis when the patient moves through the stages of care.

A positive therapeutic attitude, a focus on identifying the clinical features of MI are necessary but not sufficient conditions for an effective assessment of the risk of myocardial rupture in MI. It is desirable that the assessment steps be carried out in a room with sufficient lighting and noise isolation, equipped for patient examination, ECG recording for a patient in severe and extremely severe unstable condition.

The proposed method for assessing the risk of myocardial rupture in MI is based on a study of the results of observation of 565 men under 60 years of age about this disease in hospitals in St. Petersburg in 2000-2015. According to the inclusion criteria, patients with a glomerular filtration rate less than 30 ml/min/m ² did not participate in the study. The follow-up period for patients was up to 56 days. Myocardial rupture was registered at autopsy in seven cases. MI was diagnosed based on the recommendations of experts from the World Health Organization (1981) and the national recommendations of the All-Russian Scientific Society of Cardiology (2006, 2007, 2013) (VRSC), the European Society of Cardiology (2017) taking into account the fourth universal definition of MI (2018) with assessment in the dynamics of objective, laboratory, clinical and instrumental data. The model was obtained using statistical analysis of the database, which included 12 blocks and 265 indicators. At the first stage, with the help of binary logistic regression, indicators with significant correlations with the development of myocardial rupture were selected from the analytical base. After that, the most sensitive of them in relation to this event were taken into account. Stepwise logistic regression was used to create a model with maximum predictive power in relation to the development of myocardial rupture. ROC analysis was used to evaluate the properties of the model.

The resulting model has a sensitivity of 80.0%, a specificity of 99.5%. Her odds ratio is 804.00 and her information power (overall proportion of correctly classified outcomes) is 99.4%. The proportion of false-positive classification results is 20.0%; false negative - 0.5%. According to the parameters of the model, it can be used in practice to assess the risk of myocardial rupture in myocardial infarction in men younger than 60 years.

The application of the proposed predictive mathematical model, the claimed method facilitates the calculation of the risk of myocardial rupture in MI. This allows to estimate it with sufficient accuracy, starting from the first hours of the disease. Included in a comprehensive program of examination and treatment of patients with myocardial infarction, this method makes it possible to form a risk group among patients with a high probability of developing myocardial rupture. Thus, it helps to substantiate the decision on the treatment tactics for this group of patients (the time and volume of surgical correction), to substantiate in advance additional consultations of specialists in complex cases (cardiac surgeon, clinical pharmacologist); form the frequency of monitoring the state of heart function, assess the need for additional measures (both medical (determining the tactics of treatment and the method of correcting the gap), and administrative and social nature), starting from the first hours of the disease. Additional advantages of the proposed method are the absence of the need for additional costs, resources and time savings to clarify the necessary information about the risk. The method is available for the majority of medical workers of inpatient and outpatient care.

Consider the examples of the validity of the resulting formula.

Example 1

Patient K., 57 years old, treated at the clinic for repeated Q-MI of the inferior wall of the left ventricle with ST segment elevation, complicated by acute heart failure of severity grade 3 (according to T. Killip), pulmonary edema, complete atrioventricular block, asystole. Thromboembolism and signs of right ventricular hypertrophy were not registered on the ECG. The patient has a history of coronary artery bypass grafting. Insert the value of the variables into the equation:

Z=-19.2+0.1566⋅1+0.949⋅1+1.88⋅2+0.82×4+2.04⋅2+5.88⋅2+0.3852⋅2=-

19.2+0.1566+0.949+3.76+3.28+4.08+11.76+0.7704=5.556

The risk of developing myocardial rupture is calculated by the formula: p=1/1+2.72 ^-z

p=(1+2.72 ^-5.556 )=1/(1+0.004)=0.996 or 99.6%.

According to the calculation results, the risk of myocardial rupture was 99.6%. The patient is at high risk for myocardial rupture. The patient was in the intensive care unit during the day, at the end of the treatment period, biological death was ascertained as a result of acute cardiovascular failure. MI with myocardial rupture was verified at autopsy.

Example 2

Patient V., 54 years old, treated in the clinic for repeated Q-MI in the area of the inferior wall of the left ventricle with ST segment elevation, in the structure of complications of which pulmonary edema, acute heart failure of the 3rd severity class (according to T. Killip) were recorded. Thromboembolism was not detected. ECG showed no signs of right ventricular hypertrophy, atrioventricular block, or asystole. The patient has a history of coronary artery bypass grafting.

Insert the value of the variables into the equation:

Z=-19.2+0.1566⋅1+0.949⋅1+1.88⋅2+0.82×4+2.04⋅1+5.88⋅1+0.3852⋅2=-19, 2+0.1566+0.949+3.76+3.28+2.04+5.88+0.7704=-2.364

The risk of developing myocardial rupture is calculated by the formula: p=1/(1+2.72 ^-z ) p=1/(1+2/72 ^2.364 )=1/(1+10.6) - 0.086 or 8.6% .

According to the results of the calculation, the probability of developing myocardial rupture was 8.6%. The patient is at low risk for myocardial rupture. The patient was in the intensive care unit during the day, at the end of the treatment period, biological death was ascertained as a result of acute cardiovascular failure. MI without myocardial rupture was verified at autopsy.

Based on the foregoing, the model obtained, already at the stage of admission to the clinic, makes it possible with sufficient accuracy to identify patients with a high risk of developing myocardial rupture in the risk group for developing this condition in order to clarify the diagnosis and make an informed decision on treatment tactics as soon as possible.

An example of the implementation of the method was the study of the possibility of its use in the departments of the hospital therapy clinic of the Military Medical Academy. CM. Kirov. Its effectiveness and organizational aspects of the implementation were evaluated in practice in the period 2018-2021. The described method was used in 77 patients with MI without myocardial rupture. Subsequently, the method was tested at the hospital stage of rehabilitation of these patients in the cardiology department of the clinic. The risk of myocardial rupture in MI was assessed upon admission of the patient to the hospital. There were no errors in the calculated probability of myocardial rupture and its registration.

Thus, the novelty and feature of the proposed method lies in the fact that it includes, in a new sequence and with new components, the calculation of the probability of developing myocardial rupture in MI. It allows in a short time without increasing costs and with great reliability to assess the risk of this event and make the right decision on the tactics of treatment and prevention for the patient, starting from the first hours of MI (need, timing, type and amount of surgical correction). The use of predictive modeling in the algorithm for the diagnosis and treatment of myocardial infarction in men younger than 60 years old gives a chance to improve treatment outcomes in the group of patients at risk of myocardial rupture in myocardial infarction. The implementation of this algorithm, along with a phased program for the rehabilitation of patients at the hospital, sanatorium and outpatient stages, will increase the efficiency of diagnosis, prognosis, prevention and treatment of such patients.

Claims (12)

A method for predicting the development of myocardial rupture in myocardial infarction (MI) in men younger than 60 years, including an assessment of the risk of this event over 56 days of the disease, according to the formula: p=1/(1+e ^-z ), where e=2.72; a Z - helper function: Z=-19.2+0.1566×A+0.949×B+1.88×C+0.82×D+2.04×E+5.88×F+0.3852×G, where: A - ECG signs of right ventricular hypertrophy, 1 - no; 2 - available; B - the presence of thromboembolism, 1 - no; 2 - available; C - history of coronary artery bypass surgery, 1 - no; 2 - available; D - class of acute heart failure according to T. Killip: 1 - no; 2 - first; 3 - second; 4 - third; E - the presence of asystole, 1 - no; 2 - available; F - presence of complete atrioventricular block, 1 - no; 2 - available; G - presence of pulmonary edema, 1 - no; 2 - available, while p>0.5 indicates a high risk of myocardial rupture in MI in men younger than 60 years, and p<0.5 indicates a low risk.