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

Зыков, М. В.; Кашталап, В. В.; Полтаранина, В. А.; Dyachenko, N. V.; Lukyanchenko, I. V.; Kosmachyova, E. D.

doi:10.33667/2078-5631-2019-2-30(405)-33-36

Medicinskij alfavit

2019

DOI: 10.33667/2078-5631-2019-2-30(405)-33-36

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

М. В. Зыков

В. В. Кашталап

В. А. Полтаранина

et al.

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 Inde… Show more

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Cited by 5 publications

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To the question of the main of acute urinary retention development during myocardial infarction in young and middle-aged men predictors

A.S.¹,

Rejza²

2022

Russian Military Medical Academy Reports

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BACKGROUND: Importance in assessing the course and prognosis of myocardial infarction is given to the study of a combination of two or more chronic diseases in one patient, interconnected by a single pathogenetic mechanism. Urological diseases are not among the most common in myocardial infarction, but during this period they significantly worsen the quality of life, increase the cost of treatment and are also associated with a worse prognosis. AIM: To study the development of acute urinary retention during the acute and subacute periods of myocardial infarction risk factors in men under 60 years old to improve prevention and outcomes. MATERIALS AND METHODS: The study included men aged 1960 years with type I myocardial infarction. Patients were divided into two age-comparable groups: I study group, with acute urinary retention 22 patients; II control, without urination disorders 644 patients. A comparative analysis of the main and additional cardiovascular risk factors observation frequency, the features of the clinical course in the selected groups were performed. Pearsons Chi-square method was used to analyze the risks of developing acute urinary retention. RESULTS: The structure of cardiovascular risk factors in the study group differed from the control group in a higher frequency of coronary artery bypass surgery in the medical history (I: 31.8%; II: 8.4%; p = 0.0002) and pacing (9.1 and 0.5%; respectively; p 0.0001), as well as fibrillation and/or atrial flutter in the medical history (27.3 and 9.2%; p = 0.005), chronic cerebrovascular insufficiency (77.3 and 51.3%; p = 0.02), alcohol abuse (63.6 and 25.2%; p 0.0001), frequent (four and more per year) colds (27.3 and 12.6%; p = 0.04), cardiac arrhythmias and conduction disorders at the onset of coronary artery disease (61.9 and 24.9%; p = 0.0007), smoking for 20 years or more (36.4 and 16.8%; p = 0.003), chronic kidney disease (46.7 and 16.2%; p = 0.02), chronic infection foci of internal organs (77.3 and 39.4%; p = 0.002), urinary (27.3 and 8.6%; p = 0.006) and cholelithiasis (13.6 and 5.4%; p = 0.006). Among the features of the clinical course of the disease, the study group was distinguished by a higher incidence of multiple complications of myocardial infarction (100 and 44.0%; p 0.0001), severe and extremely severe condition of patients (59.0 and 19.6%; p 0.0001). Asystole (absolute risk: 42.1%; relative: 18.0; p 0.0001), hydrothorax (absolute risk: 41.7%; relative: 15.9; p 0.0001), the patients severe condition in the first hours of illness (absolute risk: 100%; relative: 36.5; p 0.0001), alcohol abuse (8.0%; 4.9; p 0.0001), smoking (absolute risk: 4.4%; relative: 8.0; p = 0.01) and onset of CHD with heart rhythm and conduction disturbances (7.7%; 4.6; p = 0.0001) were the most significant predictors of acute urinary retention. CONCLUSIONS: Patients with acute urinary retention are characterized by a more severe course of myocardial infarction. Combinations of listed above factors indicate an increased risk of developing this complication. It is advisable to use them for predictive modeling and the formation of risk groups for early prevention.

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To the question of the main of acute urinary retention development during myocardial infarction in young and middle-aged men predictors

A.S.¹,

Rejza²

2022

Russian Military Medical Academy Reports

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Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention

et al. 2020

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Aim To study gender aspects of comorbidity in evaluating the risk of in-hospital death for patients with acute coronary syndrome (ACS) after a percutaneous coronary intervention (PCI).Material and methods The presented results are based on data of two ACS registries, the city of Sochi and RECORD-3. 986 patients were included into this analysis by two additional criteria, age <70 years and PCI. 80% of the sample were men. Analysis of comorbidity severity was performed for all patients and included 9 indexes: type 2 diabetes mellitus, chronic kidney disease, atrial fibrillation, anemia, stroke, arterial hypertension, obesity, and peripheral atherosclerosis. Group 1 (minimum comorbidity) consisted of patients with not more than one disease (n=367); group 2 (moderate comorbidity) consisted of patients with 2 or 3 diseases (n=499), and group 3 (pronounced comorbidity) consisted of patients with 4 or more diseases (n=120). In-hospital mortality was 2.7 % (n=27).Results Significant data on the effect of comorbidity on the in-hospital prognosis were obtained only for men of the compared groups: 0.6, 1.8, and 8.8 %, respectively (χ2=21.6; р<0.0001). At the same time, among 44 women with minimum comorbidity, there were no cases of in-hospital death, and the presence of moderate (n=110) and pronounced comorbidity (n=40) was associated with a similar death rate (7.3 and 7.5 %, respectively). Noteworthy, in moderate comorbidity, the female gender was associated with a 4-fold increase in the risk of in-hospital death (odd ratio, OR 4.3 at 95 % confidence interval, CI from 1.5 to 12.1; р=0.003). In addition, both in men and women with minimum comorbidity, even a high risk by the GRACE scale (score ≥140) was not associated with increased in-hospital mortality, which was minimal (0 for women and 1 % for men). At the same time, in the patient subgroup with moderate and pronounced comorbidity, a GRACE score ≥140 resulted in a 6-fold increase in the risk of in-hospital death for men (OR 6.0 at 95 % CI from 1.7 to 21.9; р=0.002) and a 16-fold increase for women (OR 16.2 at 95 % CI from 2.0 to 130.4; р=0.0006).Conclusion This study identified gender-related features in predicting the risk of in-hospital death for ACS patients with comorbidities after PCI, which warrants reconsideration of existing approaches to risk stratification.

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The Clinical Course Features of Myocardial Infarction, Complicated by Acute Urinary Retention, in Young and Middle-Aged Men

B.A.

V.A.

A.S.

et al. 2022

Mediko-farmacevtičeskij žurnal "Pulʹs"

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Abstract. Relevance. Acute urinary retention (AUR) in myocardial infarction (MI) negatively affects the course and prognosis of the disease. Aim. To evaluate the MI clinical course of AUR development during the acute and subacute periods of disease in men under 60 years old to improve prevention and outcomes. Materials and methods. The study included men aged 19-60 years with type I myocardial in-farction. Patients were divided into two age-comparable groups: I - study group, with ACR - 22 patients; II - control, without urination disorders - 644 patients. A comparative analysis of the features of the medical history and clinical course in the selected groups were performed. Pear-son's Chi-square method was used to analyze the risks of ACR development. Results of the study. The study group differed from the control group in a higher frequency of cardiac arrhythmias and conduction disorders at the onset of coronary artery disease (I: 61.9; II: 24.9%; p = 0.0007), higher incidence of multiple MI complications (100 and 44.0%; ; respectively; p < 0.0001), severe and extremely severe condition of patients (59.0 and 19.6%; p < 0.0001). Asystole (absolute risk: 42.1%; relative: 18.0; p < 0.0001), hydrothorax (41.7%; 15.9; p < 0.0001), the patient’s severe condition in the first hours of illness (30%; 36.5; p < 0.0001), and onset of CHD with heart rhythm and conduction disturbances (7.7%; 4.6; p = 0.0001) were the most significant ACR predictors. Conclusion. Patients with ACR are characterized by a more severe MI course. Combinations of listed above factors indicate an increased risk of development this complication. It is advisable to use them for predictive modeling and the formation of risk groups for timely prevention.

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

Cited by 5 publications

References 23 publications

To the question of the main of acute urinary retention development during myocardial infarction in young and middle-aged men predictors

To the question of the main of acute urinary retention development during myocardial infarction in young and middle-aged men predictors

Comorbidity and Gender of Patients at Risk of Hospital Mortality After Emergency Percutaneous Coronary Intervention

The Clinical Course Features of Myocardial Infarction, Complicated by Acute Urinary Retention, in Young and Middle-Aged Men

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