Trends in the history and fate of patients hospitalized for acute myocardial infarction

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F18%3A00077464" target="_blank" >RIV/00023001:_____/18:00077464 - isvavai.cz</a>

Výsledek na webu

<a href="https://www.sciencedirect.com/science/article/pii/S0010865018300559" target="_blank" >https://www.sciencedirect.com/science/article/pii/S0010865018300559</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1016/j.crvasa.2018.09.001" target="_blank" >10.1016/j.crvasa.2018.09.001</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Trends in the history and fate of patients hospitalized for acute myocardial infarction

Popis výsledku v původním jazyce

The aim of the study is to report on the history of ischemic heart disease (IHD), clinical course and early and late mortality in 1291 middle-aged men (&lt;65 years) hospitalized for acute myocardial infarction in the 2006-2016 period. All patients admitted within 24 h (90% of patients) underwent angiography on arrival; urgent infarct-related artery PCI was performed in 85.4% of all patients; of these 14.6% had PCI on another (non-infarct related) artery PCI while 7.7% had coronary artery bypass grafting (CABG). Primary ventricular fibrillation and cardiogenic shock occurred in 8.6% and 5.1% of patients, respectively. Cardiogenic shock-related mortality was 53%. Twenty-eight-day mortality in our entire patient cohort was 4.8%, with one-year mortality (28 days onward to 1 year) being 1.7%. Long-term mortality of our cohort, monitored until end of 2015, was adversely affected by older age, pre-existing coronary heart disease [finding based on data above previous PCI or CABG, or previous myocardial infarction (p &lt; 0.040)], low left ventricular ejection fraction on admission (p &lt; 0.001; &lt;35%) and manifestations of acute heart failure (shock; Killip III; p &lt; 0.001). A total of 1158 patients lived longer than one year, of which number 79.3% were available for outpatient assessment at 1 year. Another non-fatal event occurred in only 8 patients (0.9%), with angina reported by 54 men (5.9%). Another aim of our study was to document changes in the history of IHD, clinical picture and death rates occurring in men in the above age category between 1970 and 2016. Analysis and comparison of these parameters were made using the World Health Organization (WHO) and European Society of Cardiology (ESC) registries as well as of our own datasets obtained between 1970 and 1977, in the 1991-1995 period (thrombolytic era) and the most recent dataset collected between 2006 and 2016. In-hospital (28-day) mortality decreased from 15 to 16.6% in the pre-reperfusion therapy period through 8.7% in the thrombolytic era down to the most recent 4.8% reported in the 2006-2016 period. This was paralleled by a decrease in one-year mortality (28+ to 365 days) declining as it did from 11.5% to the current 1.6%. Marked changes were likewise seen in the past history of patients. The incidence of pre-existing angina decreased from 42% in the 1970s to 24% in the predominantly thrombolytic era down to the current 6.1%. A similar downward trend was noted in the incidence of previous myocardial infarction, falling from 25 to 30% to the current 9.6%. The lower incidence of angina prior to the event as well as previous myocardial infarction can be attributed not only to more effective medication and secondary prevention but, also, to the current strategies of revascularization in patients with angina and early myocardial revascularization in individuals experiencing a coronary event. Taken together, the factors behind the reduced mortality of patients hospitalized for acute myocardial infarction are not only early infarct-related artery recanalization but, also, a lower incidence of a previous myocardial infarction plus better status of the coronary vascular bed in patients with previously diagnosed angina and previous myocardial infarction.

Název v anglickém jazyce

Trends in the history and fate of patients hospitalized for acute myocardial infarction

Popis výsledku anglicky

The aim of the study is to report on the history of ischemic heart disease (IHD), clinical course and early and late mortality in 1291 middle-aged men (&lt;65 years) hospitalized for acute myocardial infarction in the 2006-2016 period. All patients admitted within 24 h (90% of patients) underwent angiography on arrival; urgent infarct-related artery PCI was performed in 85.4% of all patients; of these 14.6% had PCI on another (non-infarct related) artery PCI while 7.7% had coronary artery bypass grafting (CABG). Primary ventricular fibrillation and cardiogenic shock occurred in 8.6% and 5.1% of patients, respectively. Cardiogenic shock-related mortality was 53%. Twenty-eight-day mortality in our entire patient cohort was 4.8%, with one-year mortality (28 days onward to 1 year) being 1.7%. Long-term mortality of our cohort, monitored until end of 2015, was adversely affected by older age, pre-existing coronary heart disease [finding based on data above previous PCI or CABG, or previous myocardial infarction (p &lt; 0.040)], low left ventricular ejection fraction on admission (p &lt; 0.001; &lt;35%) and manifestations of acute heart failure (shock; Killip III; p &lt; 0.001). A total of 1158 patients lived longer than one year, of which number 79.3% were available for outpatient assessment at 1 year. Another non-fatal event occurred in only 8 patients (0.9%), with angina reported by 54 men (5.9%). Another aim of our study was to document changes in the history of IHD, clinical picture and death rates occurring in men in the above age category between 1970 and 2016. Analysis and comparison of these parameters were made using the World Health Organization (WHO) and European Society of Cardiology (ESC) registries as well as of our own datasets obtained between 1970 and 1977, in the 1991-1995 period (thrombolytic era) and the most recent dataset collected between 2006 and 2016. In-hospital (28-day) mortality decreased from 15 to 16.6% in the pre-reperfusion therapy period through 8.7% in the thrombolytic era down to the most recent 4.8% reported in the 2006-2016 period. This was paralleled by a decrease in one-year mortality (28+ to 365 days) declining as it did from 11.5% to the current 1.6%. Marked changes were likewise seen in the past history of patients. The incidence of pre-existing angina decreased from 42% in the 1970s to 24% in the predominantly thrombolytic era down to the current 6.1%. A similar downward trend was noted in the incidence of previous myocardial infarction, falling from 25 to 30% to the current 9.6%. The lower incidence of angina prior to the event as well as previous myocardial infarction can be attributed not only to more effective medication and secondary prevention but, also, to the current strategies of revascularization in patients with angina and early myocardial revascularization in individuals experiencing a coronary event. Taken together, the factors behind the reduced mortality of patients hospitalized for acute myocardial infarction are not only early infarct-related artery recanalization but, also, a lower incidence of a previous myocardial infarction plus better status of the coronary vascular bed in patients with previously diagnosed angina and previous myocardial infarction.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2018

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Cor et vasa

ISSN

0010-8650

e-ISSN

—

Svazek periodika

60

Číslo periodika v rámci svazku

6

Stát vydavatele periodika

NL - Nizozemsko

Počet stran výsledku

7

Strana od-do

"E569"-"E575"

Kód UT WoS článku

000451063200002

EID výsledku v databázi Scopus

2-s2.0-85054612438