Assessment of long-term cardiovascular events in patients with acute myocardial infarction complicated by acute heart failure

Abstract

Annotation. The purpose of the study is to establish the frequency of occurrence, structure and correlation of adverse cardiovascular events among patients who have experienced an acute myocardial infarction (MI) complicated by acute heart failure (AHF). The study included 308 MI patients, among them 215 men (69.8%) and 93 women (30.2%). The average age of the examined patients was (62.9±0.6) years. Among all patients, 161 (52.3%) were diagnosed with MI without signs of AHF (I class according to Killip, group I), 44 (14.3%) had MI combined with 2nd class of AHF, and 55 (17.8%) – class III MI and AHF (patients with Killip II and III AHF were combined into group II, 99 patients), and in 48 (15.6%) cases MI and AHF class IV according to Killip (group III) were detected. All patients underwent additional laboratory examination (quantitative troponin I, D-dimer, CPK-MV, C-reactive protein, NTproBNP), echocardiography and lung ultrasound during hospitalization and upon discharge from the hospital, coronary ventriculography in supplement to the standard examination. The statistical analysis of the results was carried out in the "Statistica 7.0" program package. Character frequency (%) was determined using Pearson's χ2 test, mean value (М±m), Student’s t-test and Mann-Whitney test were used for statistical analysis, and Spearman’s correlation analysis was used. It was established that in group I there were 9 (5.6%) fatal cases during the year, in group II – 7 (7%) (р1-2=0.62), in group III – 3 (6.3%) cases (p2-3=0.54). In the group of MI with AHF II-III, there were significantly more cases of repeated MI – 4 (4%), while in group I there was no case (р1-2=0.01), and in group III there was 1 case (2.1%), (p2-3=0.54). Among the reasons for hospitalization during the year in all groups, the leading one was the progression of heart failure – from 16.7% in group III to 28.3% in group II without a significant difference between groups. Unstable angina was the reason for inpatient treatment more often in group II – 12.1% of cases and only in 4.9% in group I (р1-2=0.035). The occurrence of adverse events within 1 year among patients with MI and AHF II-III correlates with the degree of hypertension (r=0.24, p=0.014), the history of hypertension (r=0.33, p=0.0004), the presence of the atrial fibrillation in anamnesis (r=0.29, p=0.0021), creatinine level (r=0.32, p=0.0022), NTproBNP (r=0.38, p=0.0001), hemoglobin (r =-0.23, p=0.032), the number of affected vessels (r=0.28, p=0.004), the end-diastolic size of the left ventricle (r=0.31, p=0.0031), the size of the left atrium (r= 0.34, p=0.0007) and left ventricular ejection fraction (r=0.27, p=0.001). Further studies should be aimed at expanding the prediction capabilities of isolated events in patients with MI and different classes of AHF.