Akutna okluzija koronarne arterije kao pretkazatelj ishoda bolesnika s akutnim infarktom miokarda [Acute coronary occlusion as a predictor of outcome in patients with acute myocardial infarction]

Krčmar, Tomislav (2019) Akutna okluzija koronarne arterije kao pretkazatelj ishoda bolesnika s akutnim infarktom miokarda [Acute coronary occlusion as a predictor of outcome in patients with acute myocardial infarction]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Acute myocardial infarction remains the leading cause of death in the developed world, despite advances in the treatment. We used the coronary angiography to reclassify subjects into those with the angiographically occluded coronary artery and those without occlusion. Our goal was to better define the underlying pathophysiology of acute myocardial infarction. The aim of the study was to evaluate prognostic impact of acute occlusion of coronary artery on outcome. We performed observational, prospective study from January 2011-January 2017 in University Hospital Sestre milosrdnice. Follow up period lasted until 1.1.2019. The study population was 2483 patients. Mortality rates in thirty-day follow up were higher among patients with occlusive myocardial infarction (7,3% vs. 3,6%, p=0000). In the long term follow up patients with the non-occlusive myocardial infarction had higher mortality rates without statistically significance (19% vs. 21,5%, p=0,374). We identified independent risk factors for long term mortality: age, peripheral artery disease, anemia, ventricular tachycardia at admission or during PCI, glucosae levels at admission, left ventricular ejection fraction, mitral regurgitation and aortic stenosis. Patients with the occlusive myocardial infarction had higher mortality rates in thirty-day follow up. After long term follow up had better prognosis but difference didn’t meet statistical significance.

Abstract in Croatian

Akutni infarkt miokarda vodeći je uzrok smrtnosti u razvijenim zemljama unatoč napretku u liječenju. Koristeći angiografski nalaz koronarnih arterija reklasificirali smo ispitanike na one s angiografski dokazanom okluzijom koronarne arterije i na one bez okluzije. Na taj način pokušali smo se približiti točnijoj patofiziološkoj podjeli infarkta miokarda. Ispitali smo je li nalaz okluzije koronarne arterije neovisni pretkazatelj preživljenja. U opservacijskom prospektivnom istraživanju sakupljeni su podatci o ispitanicima s AIM u razdoblju od 1. 6. 2011. do 1. 1. 2017. godine. Praćenje ishoda bolesnika trajalo je do 1. 1. 2019. godine. Podatci su dobiveni iz postojećih elektronskih baza podataka u bolničkom sustavu i iz baze podataka umrlih Hrvatskog zavoda za javno zdravstvo. Na uzorku od 2483 ispitanika okluzija koronarne arterije potvrđena je kao neovisni pretkazatelj smrtnosti u praćenju od 30 dana (p=0,000). U dugoročnom praćenju nije bila neovisni pretkazatelj smrtnosti (HR 0,919, 95% CI 0,760–1,110, p=0,379). Dobiveni neovisni pretkazatelji opće smrtnosti su: dob, anemija, VT kod dolaska ili tijekom PCI, glikemija, EFLV, mitralna regurgitacija, aortna stenoza. Bolesnici s NOIM bili su stariji, s više komorbiditeta, i ukupno su dugoročno imali slabiji ishod. Bolesnici s OIM imali su viši mortalitet u kratkoročnom tridesetodnevnom praćenju dok su dugoročno imali bolju prognozu koja nije imala statističku značajnost.

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