ASSOCIATIONS OF PSYCHOSOCIAL FACTORS WITH PROBABLE HOSPITAL MORTALITY ACCORDING TO THE TIMI AND GRACE SCALES IN PATIENTS LIVING IN THE NORTH WITH ACUTE CORONARY SYNDROME
Authors: Kozhokar K G , Urvantseva I A , Lifshits G I , Nykolaev K Yu 
Published: March 2018

The aim of our research is to study associations of psychosocial factors with the probable hospital mortality according to the TIMI and Grace scales in patients with acute coronary syndrome living in the North. Materials and methods. 269 patients (female n = 57, n = 212 men) with acute coronary syndrome were examined, their average age was 56,0 ± 6,1 years (45-64 years). The complex of diagnostic studies and surveys of patients on a specially designed questionnaire consisting of general questions, the «AUDIT» test and the assessment of the psychological state of the individual was accomplished. An assessment of the severity of the coronary lesion on the SYNTAX scale was conducted; the calculation of the estimated hospital mortality rate on the TIMI and Grace scales was performed.Results. Male gender is associated with the development of alexithymia in a group of patients with a low and moderate risk of a possible hospital mortality rate on the Grace scale (r = 0.20, p <0.01). Continuance of residence in the North is associated with the development of myocardial infarction (r= 0.18, p <0.01) in the group of people with a low and moderate risk of probable hospital mortality. The direct associations of nonconventional factors with high risk of hospital-related mortality on the Grace scale in patients with acute coronary syndrome are high personal levels (OR = 1.593, 95% CI 1.373- 1.943, p = 0.027) and situational anxiety (OR = 1.728, 95% CI 1.037 -2.881, p = 0.036). The leading factors determining the severity of coronary artery disease on the SYNTAX scale in the group of patients with the high risk of possible hospital mortality according to the Grace scale are the low level of social integration (OR = 0.205, 95% CI 0.043-0.394, p = 0.012) and satisfaction with social support ( OR = 0.714, 95% CI 0.546-0.935, p = 0.014). Personal anxiety is associated with an increase in the incidence of alexithymia in high-risk patients for the probable hospital mortality rate on the TIMI scale (r = 0.40, p <0.01). Determining factors of the high risk of the probable hospital mortality on the TIMI scale are: the time from the moment of the onset of the pain syndrome to the admission of the patient to the hospital (OR = 0.580, 95% CI 0.338-0.995, p = 0.048) and low ejection fraction (OR = 0.930, 95% CI 0.875-0.988, p = 0.019).Conclusion. Directly determining nonconventional factors of high risk of possible hospital mortality on the Grace scale in patients with acute coronary syndrome living in the North are high levels of personal and situational anxiety. The age of patients and the continuance of stay in the North in patients with acute coronary syndrome do not significantly affect the level of probable hospital mortality on the Grace scale. The combination of indicators of long-term residence in the North and significant coronary bed lesion on the SYNTAX scale determine a high risk of a possible hospital mortality rate on the TIMI scale in patients with acute coronary syndrome.