IMPACT OF RISK FACTORS ON THE DEVELOPMENT OF RECURRENT CARDIOVASCULAR EVENTS IN PATIENTS WITH MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION DURING THREE YEARS OF FOLLOW-UP

Abstract

Introduction. Patients following myocardial infarction (MI) have a high risk of developing recurrent MI as well as progression of other cardiovascular diseases. Most studies exami­ning outcomes in patients with MI have focused on the acute phase after the index event. In addition, the available scales for predicting early and long-term outcomes of patients with acute coronary syndrome practically do not take into account the phenomenon of comorbidity. The aim of the study — to identify risk factors influencing the development of recurrent cardiovascular events (CVE) during three years of follow-up in patients with acute ST-segment elevation myocardial infarction (STEMI). Materials and methods. Our study included 256 patients diagnosed with STEMI who underwent thrombolytic therapy followed by stenting of the infarct-related artery. The group included 180 men (70%) and 76 women (30%), the mean age of whom was 63.7±0.6 years. During follow-up of the patients for three years after the index event, the results of echocardiogram and lipidogram were evaluated, and recurrent cardiovascular events were analyzed. Research results. Patients were divided into two groups: Group 1 — 177 patients with CVE (69%), Group 2 — 79 patients without CVE (31%). It was revealed that acute kidney injury was diagnosed more often in group 1 than in group 2 — 22 (12.4%) and 1 (1.3%) (p=0.008). The manifestation of acute heart failure at Killip II level in the index hospitalization was 45 (25.4%) patients in the group with CVE and 10 (12.7%) in the group without CVE (p=0.037). The Charlson comorbidity index in group 1 patients was statistically significantly higher than in group 2 patients and was 4.5±0.15 and 3.3±0.15 points (p <0.001). Type 2 diabetes mellitus was statistically significantly more frequent in the group of patients with CVE than without (41 (23.2%) cases to 7 (8.9%) cases p=0.017). Atrial fibrillation was more frequent in 32 (18.1%) patients in group 1 and 3 (3.8%) patients in group 2, which was statistically significant (p=0.004). In group 1, 14 (7.9%) patients had previously suffered an acute cerebral circulation disorder (p=0.023). Group 1 patients were more often obese than group 2 — 75 (42.4%) and 19 (24.1%) (p=0.005). Conclusions. Thus, as a result of the study it was shown that recurrent CVE within 3 years of follow-up are more frequent in patients with obesity, Charlson comorbidity index of 4 and more points, who have a history of acute cerebral circulatory failure, atrial fibrillation, diabetes mellitus and chronic heart failure, as well as those who have suffered in the early postinfarction period such complications as: acute kidney injury, acute heart failure at Killip II level and above.