Cardiology Letters 2012, 21(4):295-307

Long-term prognosis of patients after acute myocardial infarction in 2006-2007 from the Bratislava V district

Danková M¹, Jurkovičová O¹, Hricák V², Kalužay J¹, Remišová S¹, Valkovičová T¹, Ponťuch P¹

¹ IV. interná klinika LFUK a UNB, Nemocnica sv. Cyrila a Metoda v Bratislave

² Oddelenia akútnej kardiológie, Národný ústav srdcových a cievnych chorôb a.s. v Bratislave, Slovenská republika

Aim of the study: The aim was to analyze clinical characteristics, treatment, and prognosis with regard to risk factors in patients with a history of acute myocardial infarction in 2006-2007 from the Bratislava V district and to determine the survival of these patients on average of 35 months after myocardial infarction.

Patients and Methods: From medical records we retrospectively analyzed a group of 155 patients from the Bratislava V district who were, from January 2006 to December 2007, hospitalized with acute myocardial infarction in Intensive Care Unit of 4th Department of Internal Medicine of St. Cyril and Methodius University Hospital in Bratislava, and the Department of Acute Cardiology of the National Institute of Cardiovascular Disease. On an average 35 months after myocardial infarction, we addressed 121 surviving patients with a questionnaire that was focused on the modifying risk factors of atherosclerosis, subjective difficulties and current treatment. Data were analyzed by statistical program JMP 7. We investigated distribution of survival rates with the Kaplan-Maier analysis.

Results: From a total of 155 patients hospitalized with acute myocardial infarction, there were 103 men and 52 women. The average age was 62.4 ± 12,5 years. We found in 89 (57.4%) cases a myocardial infarction with ST segment elevation and in 66 (42.6%) cases a myocardial infarction without ST segment elevation. Men dominated in the STEMI group (74%). Women with STEMI were significantly older (p=0.0006). We recorded the incidence of arterial hypertension, hyperlipidemia, and active smoking in 1/5 of the patients with STEMI. The incidence of arterial hypertension was more frequent in women (p=0.009), prevalence of hyperlipidemia was the same in both genders. There were more smokers among men compared to women (p=0,0007). Almost one quarter of patients with STEMI were diabetics. The incidence of diabetes between the sexes, despite the age difference, was not statistically significant. In the NSTEMI group we found out a history of arterial hypertension in 21 women, representing 91.3% of the total number of NSTEMI women (p=0.008). The proportion of male smokers in NSTEMI group was significantly higher than in women (48% versus 17%, p=0,008). Coronary angiography was performed in 77.5% of patients with STEMI and 42.4% of patients with NSTEMI. One-vessel disease was the most prevalent (45.9%), three-vessel disease was significantly more frequent in the NSTEMI group (39.3% versus 5.8%, p <0.001). Percutaneous coronary intervention was performed in 71.9% of STEMI patients and 10.6% of NSTEMI patients. GRACE score on admission correlated clearly with inpatient mortality (p<0.001). Inpatient mortality in the entire group was 10.9%: we found no significant difference between patients with STEMI (12.3%) and NSTEMI (9.1%) and a prevailing number of females in STEMI group (p=0.002). Late mortality rate 35 months after the first hospitalization was significantly higher in the NSTEMI than STEMI group (16.7% versus 6.7%, p<0.05). Overall, in the STEMI group, inpatient and late mortality was 19.0%, while in the NSTEMI group this increased to 25.8% (p=0.33). Hospitalization for recurrent myocardial infarction after discharge was higher in patients with NSTEMI (p=0.03). Survival curves showed worse prognosis of patients with NSTEMI (p=0.011), more significantly in males (p=0.017) - smokers and diabetics. We sent the questionnaire to 121 living patients and we received replies from 88 patients (72.7%). Despite myocardial infarction, nearly 26% of patients were active smokers, with a clear predominance of males (91.3% of smokers). Nearly 53% of patients had changed their diets, although 25% patients had increased their weight. Physical activity was comparable before and after myocardial infarction. Up to 63% of patients reported the occurrence of such difficulties as chest pain and breathlessness.

Conclusion: Treatment of patients with acute myocardial infarction is in accordance with generally accepted recommendations. The male population after NSTEMI in our study had a worse long-term prognosis compared with women in the same group. In addition to long-term drug therapy, the non-pharmacological modification of risk factors, which is not sufficient, is necessary. The number of patients with NSTEMI, who underwent coronary angiography and PCI is significantly low.

Keywords: acute myocardial infarction; percutaneous coronary intervention; risk factors for acute myocardial infarction; long-term prognosis of patients with STEMI and NSTEMI

Published: April 1, 2012  Show citation