Risk markers of complications of acute myocardial infarction in long-term follow-up depending on the age of patients | Український Медичний Часопис

The aim is to identify risk markers for complications of acute myocardial infarction (AMI) in long-term follow-up, depending on the age of the patients. Object and research methods. The data of remote monitoring of patients hospitalized with a diagnosis of «Acute coronary syndrome with ST segment elevation» and undergoing treatment in the intensive care unit were analyzed. Depending on age, patients are divided into two groups: 1-st (n=160) — <45, 2-nd (n=457) — ≥45 years. The mean follow-up was 4.89±2.66 years. We evaluated the death rate from any causes within 5 years of observation, the development of a combined endpoint (CEP), cardiovascular death (CVD)/AMI/stroke over 5 and 10 years. Results. Patients of the 1st group had significantly better survival during 10 years of observation than the 2nd (Log-rank test — LRT; p=0.027). The difference in the curves was determined after the 1-st year of observation (LRT; p=0.031), as well as after 3; 5 and 10 years. CVD or repeated AMI was also more often observed in patients of the 2-nd group (LRT; p=0.021). Patients aged <35 years showed better survival rates among the studied subgroups; with increasing age, the frequency of complications increased. Arterial hypertension is the main risk factor for the development of long-term complications in young patients (relative risk 4.0; 95% confidence interval 1.5–10.7; p=0.006). Patients with a low left ventricular ejection fraction (LV EF) (<40%) on the 1-st day after AMI had a high probability of death from any causes within 5 years of follow-up (relative risk 3.4; 95% confidence interval 1.2–2.05; p=0.022). Patients who underwent myocardial revascularization during the first 3 years had significantly fewer ischemic complications (CVD/repeated AMI/stroke) (LRT; p=0.048). Findings. Patients of a young age (<45 years) with AMI are characterized by fewer complications during a long (<10 years) out-of-hospital observation period compared with the older age group. Among the risk factors for recurring cardiovascular events in these patients are concomitant arterial hypertension and LV dysfunction. However, reduced LVEF (<40%) upon admission was more important for the death within 5 years of observation, and maintaining values <50% on the 5–7-th day of the disease was important for the development of CEP. Myocardial revascularization (thrombolysis or primary percutaneous intervention) reduces the risk of developing CEP only during the first 3 years of observation, then its positive value is lost. The absence of hemodynamically significant stenosis of the coronary arteries according to coronary ventriculography, the age <35 years and the timely conduct of drug or mechanical myocardial revascularization indicate a low risk of complications during prolonged observation.

Published: 27.08.2019

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