Acute coronary syndrome (ACS) is a term used to describe a range of conditions (acute ischemia and/or infarction) associated with an abrupt reduction in coronary blood flow. Acute coronary syndrome is the commonest cause of morbidity and mortality in patients with coronary heart disease (CAD), contributing to an estimated 7.4 million deaths annually. It can be caused by a very tight stenosis and plaque rupture which is the most frequent cause of coronary thrombosis. Platelets usually aggregate on the site, thus limiting blood flow that increases rate of death in ACS patients. Acute coronary syndrome encompasses ST-elevated myocardial infarction, non ST-elevated, myocardial infarction and unstable angina[6]. ST-elevated myocardial infarction (STEMI) is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent ST elevation and subsequent release of biomarkers of myocardial necrosis. It is caused by complete occlusion of the culprit artery and mostly diagnosed in the presence of ischemic chest pain. Troponin (T or I), the biomarker of choice to diagnose myocardial necrosis, is often normal during the first few hours of STEMI, thus emergent percutaneous coronary intervention (PCI) can be helpful. Whereas, unstable angina (UA) and non ST-elevation (NSTEMI) are caused by incomplete occlusion of the culprit artery in 60–90% of cases.

Different factors were reported to have a strong correlation with the incidence of ACS and treatment outcomes. Some of the strongest predictors of ACS outcomes include a history of diabetes mellitus, hypertension, hyperlipidemia, family history of ACS, and smoking.^5,13–17 Similarly, the findings of an Ethiopian study also revealed that history of hypertension, being Killip class III and IV, and STEMI diagnosis were independent predictors of death.¹² The recovery rate of ACS patients was also determined by coronary revascularization, percutaneous coronary intervention, major bleeding, defibrillation, hospital stay, and age at admission.^18–20

ACS encompasses a variety of disorders, including patients with recent changes in clinical symptoms or indications, alterations on the electrocardiogram (ECG), and a sudden increase in cardiac troponin (cTn) concentrations. ACS is linked to a variety of clinical presentations, including asymptomatic patients, patients with chronic chest pain or discomfort, cardiac arrest, electrical or hemodynamic instability, and cardiogenic shock [2].Furthermore, the majority of deaths occur during the early stages of ACS, specifically within the first 24 hours of the patient's hospitalization [3]. As a result, when ST-elevation or non-ST-elevation ACS (ST-elevation) occurs, the physician requires a "tool" to estimate the probability of death in order to make timely decisions and optimize patient management. To now, such a "tool" for assessing the likelihood of an undesirable outcome in patients consists of multivariate scales, the strength and significance of which are confirmed by ROC analysis [4]. Currently, there are numerous scales and methodologies for estimating the risk of death (GRACE, TIMI, PURSUIT, EuroSCORE II, RECORD), but they mostly consider well-known "classical" risk variables [6].However, when analyzing the research data, it should be noted that the search for universal predictors for assessing the risk of in-hospital mortality continues, combining a number of criteria: ease of use, taking into account the impact of comorbidity, as well as the results of laboratory and instrumental research methods [5]. That is why the establishment of a set of prognostic factors can help optimize risk stratification and accurately assess the probability of death at the hospital stage.

ACS, predictors, lethality, comorbidity.

1. Federal State Statistics Service. The Demographic Yearbook of Russia. Statistical Handbook. - M.: Rosstat. 2023. - 256p. [Russian: Federal State Statistics Service. Demographic Yearbook of Russia. Statistical Collection. - Moscow: Rosstat. 2023. - 256 p. Available on: https://rosstat.gov.ru/storage/mediabank/Demogr_ejegod_2023.pdf]

2. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. 2023; 44(38):3720–826. DOI: 10.1093/eurheartj/ehad191

3. Korotaeva E.S., Koroleva L.Yu., Kovaleva G.V., Kuzmenko E.A., Nosov V.P. Major predictors of stent thrombosis in patients with acute coronary syndrome following transcutaneous coronary intervention who received different double antiplatelet therapy. Kardiologiia. 2018; 57(S1):12–21. [Russian: Korotaeva E.S., Koroleva L.Yu., Kovaleva G.V., Kuzmenko E.A., Nosov V.P. Main predictors of stent thrombosis in patients with acute coronary syndrome after percutaneous coronary intervention against the background of various double antiplatelet therapy. Cardiology. 2018; 58(S1):12-21]. DOI: 10.18087/cardio.2423

4. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018; 39(2):119– 77. DOI: 10.1093/eurheartj/ehx393

5. Castro-Dominguez Y, Dharmarajan K, McNamara RL. Predicting death after acute myocardial infarction. Trends in Cardiovascular Medicine. 2018; 28(2):102–9. DOI: 10.1016/j.tcm.2017.07.011

6. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2021; 42(14):1289–367. DOI: 10.1093/eurheartj/ehaa575

Pencina, M.J.; Navar, A.M.; Wojdyla, D.; Sanchez, R.J.; Khan, I.; Elassal, J.; D’Agostino, R.B.; Peterson, E.D.; Sniderman, A.D. Quantifying Importance of Major Risk Factors for Coronary Heart Disease. Circulation 2019, 139, 1603–1611. [

Gerland, P.; Hertog, S.; Wheldon, M.C.; Kantorova, V.; Gu, D.; Gonnella, G.; Williams, I.; Zeifman, L.; Bay, G.; Castanheira, H.C.; et al. World Population Prospects 2022: Summary of Results; United Nations: San Francisco, CA, USA, 2022; pp. 3–12.