| Autor: |
Pereverzeva KG; Ryazan State Medical University named after academician I.P. Pavlov, Ryazan., Lukyanov MM; State National Medical Research Centre for Preventive Medicine, Moscow., Andreenko EY; State National Medical Research Centre for Preventive Medicine, Moscow., Klyashtorny VG; State National Medical Research Centre for Preventive Medicine, Moscow., Pravkina EA; Ryazan State Medical University named after academician I.P. Pavlov, Ryazan., Drapkina OM; State National Medical Research Centre for Preventive Medicine, Moscow., Yakushin SS; Ryazan State Medical University named after academician I.P. Pavlov, Ryazan. |
| Abstrakt: |
Aim To determine the factors that influence the long-term prognosis in patients after myocardial infarction (MI) as a part of the prospective REGistry of pATients after myocArdial infarction (REGATA).Material and methods In 2012-2013, 481 post-myocardial infarction patients were included into the REGATA registry; 247 (51.4 %) were men, median age 72 [62; 78] years. The median duration of prospective follow-up after the inclusion into the registry was 6.1 [4.0-6.6] years. Data were obtained for 474 (98.5 %) patients. Statistical analysis was performed with the Microsoft Excel 2010, StatsoftStatistica10.0 software and partially manually by formulas. Methods of descriptive statistics were used. For quantitative variables with normal distribution, mean values and standard deviations were calculated; intergroup differences were evaluated with Student's t-test. Differences between groups of survived and deceased patients were evaluated with a nonparametric method using the Pearson's chi-squared test with a Yates's correction, and the Fisher's exact test. When the frequency of absent data for the studied variable exceeded 20 %, this variable was not included into the analysis. The 6-year survival was analyzed by the Kaplan-Meier method. Fatal outcomes were analyzed with the Cox proportional hazards regression model. Differences were considered significant at p<0.05.Results During the follow-up period, there were 200 (41.6 %) cases of all-cause death and 123 (25.6 %) cases of cardiovascular death; 39 (8.1 %) of patients had acute cerebrovascular disease (ACVD) and 36 (7.5 %) had recurrent myocardial infarction. The median time from the inclusion into the registry to death was 3.4 [1.6; 5.1] years. A higher risk of all-cause death was significantly associated with factors of age (one-year relative risk, RR, 1.03; 95 % confidence interval, CI, 1.02-1.05; р<0.001), III-IV functional class angina (RR, 1.76; 95 % CI, 1.22-2.53; p=0.003), history of ACVD (RR, 2.12; 95 % CI, 1.50-2.98; p<0.001), atrial fibrillation (AF) (RR, 1.52; 95 % CI, 1.10-2.12; р=0.01), diabetes mellitus (DM) (RR, 1.53; 95 % CI, 1.11-2.10; p=0.009), chronic obstructive pulmonary disease (COPD) (RR, 1.77; 95 % CI, 1.20-2.62; p=0.004), and reduced hemoglobin (RR, 2.09; 95 % CI, 1.31-3.33; p=0.002). A lower risk of death was associated with administration of antiplatelets (RR, 0.57; 95 % CI, 0.37-0.89; p=0.01), angiotensin-converting enzyme (ACE) inhibitors /angiotensin II receptor blockers (ARB) (RR, 0.51; 95 % CI, 0.33-0.78; p=0.002), and statins (RR, 0.48; 95 % CI, 0.34-0.67; p<0.001). A higher risk of nonfatal stroke during the follow-up was significantly associated with age (one-year RR, 1.05; 95 % CI, 1.01-1.09; р=0.02), history of ACVD (RR, 2.74; 95 % CI, 1.33-5.63; p=0.006), and DM (RR, 2.43; 95 % CI, 1.17-5.06; p=0.02), and a higher risk of nonfatal stroke was significantly associated with a history of ACVD (RR, 1.70; 95 % CI, 1.44-2.01; p<0.001), DM (RR, 2.33; 95 % CI, 1.13-4.84; p=0.02), and COPD (RR, 2.47; 95 % CI, 1.02-6.00; p=0.06).Conclusion In the outpatient REGATA registry that included patients with MI at any previous time, the death rate for 6 years of follow-up was 41.6 %. In 61.5 % of cases, death was caused by cardiovascular diseases. In clinical practice in long-term, a higher risk of unfavorable outcome was associated with old age, III-IV functional class angina, a history of ACVD, AF, DM, and COPD while a lower risk was associated with the administration of antiplatelets, ACE inhibitors/ARB, and statins. |
