Predictive importance of comorbidity in patients with myocardial infarction and different strategy of treatment

Abstract

The aim of the study was to compare the 1-year results of conservative and invasive tactics of treating myocardial infarction (MI) in patients with different severity of comorbid background.Material and methods. The presented results are based on registry in City Hospital No. 4 of Sochi. The present analysis included patients with a diagnosis of myocardial infarction (n = 1 176). Upon discharge from the hospital, all patients underwent analysis of the severity of comorbidity using the Charlson Comorbidity Index (CCI). A year later, 791 patients managed to find out the prognosis after discharge from the hospital. 1-year mortality was 12.6 % (n = 100).Results. The frequency of coronary angiography (CA) and percutaneous coronary intervention (PCI) in patients with CCI = 0 (no or minimal comorbidity, n = 408) was 84.3 % and 63.5 %, with a CCI of 1–2 (moderate comorbidity), n = 438) was 68.0 % and 44.8 %, with CCI ≥ 3 (expressed comorbidity, n = 330) was 50.3 % and 25.8 %, respectively. At the same time, conducting PCI at the hospital observation stage was associated with a decrease mortality during the year after discharge from the hospital from 18.5 % to 5.8 %, p < 0.0001. The greatest positive effect of PCI for optimizing the long-term prognosis of (1 year) was achieved in the group of patients with severe comorbidity (CCI ≥ 3), where the NNT (number needed to treat) was 7. The relative risk of 1-year mortality in patients with severe comorbidity compared to the minimum in the PCI group was 6.75, in the conservative treatment group was 4.63.Conclusion. The results of this study showed that PCI in MI is more often performed by younger, less comorbid patients with a lower risk on the GRACE scale. At the same time, the 1-year survival of patients with MI was significantly higher after PCI compared to the primary conservative treatment strategy, regardless of the severity of comorbidity, and the greatest improvement in the long-term prognosis of PCI was observed in patients with severe comorbidity, as determined by the CCI ≥ 3.